Ergonomics is the study of how humans and machines interact. More specifically, it addresses the interplay between humans and machines through an examination of optimal positioning of equipment and personnel to allow for the most efficient work play and use of time and space. With its study and importance growing in scope following the invention of the assembly line by Henry Ford in 1913, ergonomics has now found itself as a focal point for many physicians in the modern-day operating room. Often found in prolonged, fixed positions and performing strenuous, repetitive motions, surgeons can experience an increased intensity of pain throughout and especially at the end of their careers. With this pain and decline in overall quality of life, surgeons are also arguably at an increased risk of committing surgical errors, thus jeopardizing patients and their safety.
Over time, the idea of ergonomics has gained traction within the surgical community to address certain medical errors and, unfortunately, shortened careers. Ergonomics has, in particular, been implemented in the otolaryngology field. With individual surgeon preference and a plethora of different procedures and setups within the subspecialties of rhinology, plastic surgery, head and neck, otology and sleep medicine, however, it is then difficult to make a comprehensive summary suggesting how and when to apply ergonomics in the most appropriate way within the field of otolaryngology. Nevertheless, basic principles seem to apply to all fields with regard to ergonomics.
First and foremost, relaxed positioning is of the utmost importance when it comes to efficiency in otolaryngology surgical procedures. The neck should generally be held in a neutral or mildly flexed position, with the shoulders relaxed and arms held close to the body in a slightly extended or adducted position. The elbows should be supported while operating, with the wrists held in a neutral position and not flexed. Also important is the number and positioning of monitors and foot pedals in the operating room. Both should be limited as seen fit, with monitors placed at eye level and foot pedals within easy reach. Sitting or standing during individual procedures is debatable, with different surgeons recommending one over the other. Nevertheless, the table height should be positioned to allow the surgeon to not have to perform any extraneous activity during their procedure(s).
Even with these suggestions and collated ideas regarding optimal ergonomic setups in otolaryngology, the fact that ergonomics isn’t initially a part of medical school and then otolaryngology residency curriculum in many parts of the country makes the implementation of the above principles an uphill battle. One way to help ensure that surgeons and otolaryngologists, in particular, have prolonged and healthy careers is to introduce the study of ergonomics early in schooling and continue to pool data from practitioners across the country to continue to better define what’s needed to ensure optimal physician and patient safety. Only then will the principles of ergonomics be utilized to their utmost potential.
Theodore Klug is an otolaryngology resident. Rachad Mhawej is an otolaryngologist.
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