Ergonomics in endoscopic sinus surgery:: Systematic review of the literature

Objective: To conduct a systematic review of reports on the ergonomic posture of the surgeon during endoscopic sinus surgery. Study Design: Literature review. Methods: Systematic review of the French- and English-language literature using PubMed from January 1970 to March 2004. Articles were divided into four categories: visualization through an endoscope or a videoendoscope, monitor position, sitting or standing position, and arm support. Results: Endoscopic sinus surgery with direct vision through the endoscope is associated with faulty neck positioning and does not appear to bring any advantages in terms of surgical performance compared with vision via a video monitor. Low back pain and lower extremity complaints are commonly associated with the standing position. Spinal flexion seems more harmful than a straight posture. The preferred viewing angle for video monitors is a few degrees below the horizontal gaze line. An arm support can be beneficial because it is associated with minimization of neck, shoulder, and lumbar stress. Conclusion: We recommend (1) visualization via a television monitor instead of direct vision through an endoscope, (2) positioning the screen in direct axis with the surgeon's body and a few degrees below the horizontal line of gaze, (3) surgery in the seated position instead of the standing position, and (4) the use of an elbow support for the arm holding the endoscope.