Ergonomic analysis of the surgical position in functional endoscopic sinus surgery

Background: Ergonomics is the methodologic study of people's efficiency in their work environment and is based on anatomy, physiology, psychology, and engineering. Although highly studied in other work environments, little attention has been paid to surgeons until the landmark survey by Park et al in 2010. Many unique aspects of endoscopic surgery amplify task-related physical discomfort, and, because of these issues, we aimed to study the physical fatigue effects of functional endoscopic sinus surgery (FESS) performed in the standing and sitting positions. Methods: Bilateral FESS was performed in 8 cadaver heads (4 in the standing position, 4 in the sitting position), following established ergonomic principles. Physical fatigue was assessed using a 27-point physical discomfort questionnaire, surface electromyography (EMG), and the NASA Task Load Index Survey. Paired and unpaired t tests were used for statistical analysis. Results: Physical fatigue was noted after FESS performed in both positions. An overall similar task burden was seen when comparing the 2 positions, although the sitting position was more "frustrating" (p < 0.05). Discomfort after FESS in the standing position was worse in the legs and low back, whereas, in the sitting position, it was seen predominantly in the upper back and arms (p < 0.05). Mean power frequency EMG measurements demonstrated fatigue of major muscle groups in both positions. Conclusion: Significant physical fatigue is reported after a single FESS operation, with measurable EMG changes. Surgeons should be aware of the short- and long-term physical implications of their daily tasks, and should use this information to be proactive in decision-making for their longevity.