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Musculoskeletal demands in microsurgery—an explorative study comparing the ergonomics of microscope and 3D exoscope

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Abstract

To assess neurosurgeons’ physical demands and investigate ergonomic aspects when using microsurgical visualization devices. Six neurosurgeons performed micro-surgical procedures on cadaveric specimens using the prototype of a digital 3D exoscope system (Aeos®, Aesculap, Tuttlingen, Germany) and a standard operating microscope (Pentero 900, Zeiss, Oberkochen, Germany) at two different patient positions (semisitting (SS), supine (SP)). The activities of the bilateral upper trapezius (UTM), anterior deltoid (ADM), and lumbar erector spinae (LEM) muscles were recorded using bipolar surface electromyography and neck flexion, arm abduction, and arm anteversion angles by gravimetrical posture sensors. Perceived discomfort frequency was assessed and subjects compared the two systems in terms of usability, posture, physical and mental demands, and working precision. Using the exoscope led to reduced ADM activity and increased UTM and LEM activity during SS position. The neck was extended when using the exoscope system with lower arm anteversion and abduction angles during the SS position. Subjects reported discomfort at the shoulder-neck area less frequently and lower physical demands when using the Aeos®. However, mental demands were slightly higher and two subjects reported lower working precision. The exoscope system has the potential to reduce the activity of the ADM by changing surgeons arm posture which may be accompanied by less discomfort in the shoulder-neck area. However, dependent on the applied patient position higher muscle activities could occur in the UTM and LEM.

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Acknowledgements

The authors sincerely thank those who donated their bodies to science. Thanks to their generosity new knowledge can be acquired that allows improving patient care. The donors and their families deserve our highest gratitude. The authors thank the students Angelika Schenk and Mona Bär for their help during the measurement preparations and data collection.

Availability of data and materials

Datasets can be assessed contacting BS or FHE.

Funding

This work was funded by the Aesculap AG, Tuttlingen, Germany (part of B. Braun Melsungen, Germany) and own resources of the institute of Occupational and Social Medicine and Health Services Research, Tübingen. The Aesculap AG was not involved in developing the study design, data assessment, data analysis or interpretation at any time. Generally, the work of the Institute of Occupational and Social Medicine and Health Services Research is financially supported by an unrestricted grant of the employers’ association of the metal and electrical industry Baden-Württemberg (Südwestmetall).

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Authors and Affiliations

  1. Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany

    Benjamin Steinhilber & Robert Seibt

  2. Department of Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany

    Laura Conte, Stephan Herlan & Marcos Tatagiba

  3. Institute of Clinical Anatomy and Cell Analysis, University Hospital Tübingen, Tübingen, Germany

    Stephan Herlan

  4. Department of Neurosurgery, Alfried Krupp Hospital Rüttenscheid, Alfried-Krupp-Straße 21, 45131, Essen, Germany

    Florian H. Ebner

Authors
  1. Benjamin Steinhilber
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  2. Laura Conte
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  3. Robert Seibt
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  4. Stephan Herlan
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  5. Marcos Tatagiba
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  6. Florian H. Ebner
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Contributions

BS and FHE initiated the research project. BS, RS, and FHE conceived and designed the study protocol. BS, RS, SH and LC prepared and performed data acquisition. BS and LC prepared the data before BS performed the statistical analysis. BS drafted the manuscript. FHE and MT revised the manuscript. All authors were included in data interpretation process. All authors critically reviewed and revised the manuscript. All authors approved the final manuscript. The results of this study are also used in the doctoral thesis of LC.

Corresponding author

Correspondence to Florian H. Ebner.

Ethics declarations

Ethical approval

The study received approval by the ethics committee of the University of Tübingen (number 252/2019BO1). The study was performed in accordance with the principles of the Helsinki Declaration of 1975, as revised in 2008.

Competing interests

The authors BS, RS, LC, SH, MT declare that there are no conflicts of interest. FHE is scientific consultant to BBraun, Aesculap.

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Steinhilber, B., Conte, L., Seibt, R. et al. Musculoskeletal demands in microsurgery—an explorative study comparing the ergonomics of microscope and 3D exoscope. Neurosurg Rev 46, 164 (2023). https://doi.org/10.1007/s10143-023-02076-3

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  • DOI: https://doi.org/10.1007/s10143-023-02076-3

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