Ergonomics in Endoscopic Transsphenoidal Surgery: A Survey of the North American Skull Base Society.

Objective Different surgical set-ups for endoscopic transsphenoidal surgery (ETS) have been described, but studies on their ergonomics are limited. The aim of this article is to describe present trends in the ergonomics of ETS. Design and Participants A 33-question, web-based survey was sent to North American Skull Base Society members in 2018 and 116 responded to it (16% of all members). Most respondents were from North America (76%), in academic practice (87%), and neurosurgeons (65%); they had more than 5 years of experience in ETS (73%), had received specific training (66%), and performed at least 5 procedures/mo (55%). Results Mean reported time for standard and complex procedures were 3.7 and 6.3 hours, respectively. The patient's body is usually positioned in a straight, supine position (84%); the head is in a neutral position (46%) or rotated to the side (38%). Most surgeons perform a binostril technique, work with a partner (95%), and operate standing (94%), holding suction (89%) and dissector (83%); sometimes the endoscope is held by the primary surgeon (22-24%). The second surgeon usually holds the endoscope (72%) and irrigation (42%). During tumor removal most surgeons stand on the same side (65-66%). Many respondents report strain at the dorsolumbar (50%) or cervical (26%) level. Almost one-third of surgeons incorporate a pause during surgery to stretch, and approximately half exercise to be fit for surgery; 16% had sought medical attention for ergonomic-related symptoms. Conclusion Most respondents value ergonomics in ETS. The variability in surgical set-ups and the relatively high report of complaints underline the need for further studies to optimize ergonomics in ETS.

Work-related musculoskeletal disorders among endoscopic transsphenoidal surgeons: a systematic review of prevalence and ergonomic interventions.

Endoscopic transsphenoidal surgery is a surgical technique introduced in the last 20 years for the treatment of skull base pathologies and, in particular, pituitary tumours. Although the prevalence of work-related musculoskeletal disorders is usually significantly higher in endoscopists and minimally invasive surgeons compared to other surgical and medical specialties, reviews on the prevalence of disorders among neurosurgeons dedicated to endoscopic transsphenoidal surgery are not available. This article performs a systematic review to identify the work-related musculoskeletal disorders among transsphenoidal neurosurgeons, their prevalence and the ergonomic interventions proposed to reduce risk factors and prevent disorders. The results show that the ergonomics of transsphenoidal neurosurgeons is an under-investigated topic. Indeed, specific prevalence data are not available. In addition, only a few papers suggest interventions and guidelines, but without objective assessment of the outcomes to confirm the ergonomic benefit. Based on these gaps in the literature, a future research agenda is proposed.

Oxygen deficiency hazard in confined spaces in the steel industry: assessment through predictive models.

Objective. In the steel industry, performing activities in confined spaces where potential oxygen displacement can occur may expose workers to fatal consequences. To the best of our knowledge, no quantitative exposure assessment of oxygen deficiency in steel industry confined spaces is available in the literature. To overcome this gap, we performed oxygen deficiency hazard (ODH) assessments in real confined spaces using two existing models to identify the most critical parameters responsible for ODH, and suggest controls for mitigating the asphyxiation risk. Methods. We applied a well-mixed model and a near field-far field approach to estimate the indoor oxygen level with time during and following release of simple asphyxiants. Model inputs were mainly gathered thanks to audits and instrumental tests in three firms. Results. The most severe ODH exposures are posed in spaces with restricted volume and where accidental releases of inert gases can occur. Such exposures can be controlled through early release detections and augmented reality systems. Conclusions. ODH assessments in confined spaces of steel firms allow the identification of the most critical parameters from an oxygen depletion perspective, focusing on which data need careful measurement, and help to establish controls compatible with the operations conducted in these areas.