Ergonomics of 3D-exoscope versus the operating microscope in otologic surgery

Introduction: Surgeons experience one of the highest rates of work-related musculoskeletal disorders, with otologists identified as a high-risk specialty. This is commonly attributed to the frequent use of the operating microscope, as it often necessitates prolonged, ergonomically unfavourable, awkward postures. Robotic 3D-exoscopes have emerged as a potential tool in improving surgical ergonomics without compromising on visualisation. This study compares the ergonomic risk associated with both devices. Methods: A prospective, single centre, ergonomic analysis was conducted on otolaryngologists performing major otologic surgery using the OPMI Sensera operating microscope (Zeiss) and RoboticScope 3D-exoscope (BHS Technologies). Ergonomic risk was evaluated using the Rapid Upper Limb Assessment (RULA) tool and a questionnaire based on the NASA Task Load Index. Results: Eighteen cases were performed; nine using the 3D-exoscope and nine using the operating microscope. Use of the 3D exoscope significantly reduced ergonomic risk, with a lower mean RULA score (4.0) compared to the microscope (5.9). Subjectively, surgeons reported reduced physical strain, effort and weakness when using the 3D-exoscope compared with the microscope, with similar cognitive and mental workload. Image quality, magnification, colour contrast, ease of use and usability of the 3D-exoscope were rated positively. Further, the 3D-exoscope was also rated highly for its educational value. Conclusion: 3D-exoscopes appear to be more ergonomically favourable and suitable when compared to the operating microscope for major otologic surgery. Continued development and larger scale studies are warranted to improve ergonomics in otologic surgery and can also inform ergonomic improvements across other surgical specialties.