Last updated: 5/1/22 at 6:00pm
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Increasing evidence demonstrates that a surgeon’s operating posture can contribute to chronic pain. Specifically, trapezius muscle fatigue has been shown to be highest when neck flexion exceeds 30°. This study sought to accurately measure the surgeon’s neck flexion angle while performing ear surgery, comparing the risks of traditional “heads down” surgery to that of “heads up” endoscopic surgery
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Nowadays, there is more and more evidence suggesting that specific posture of surgeon while operating can contribute to discomfort, cervical musculoskeletal strain, and chronic pain. Postural neck pain can be caused by several factors. The persistent neck flexion, long periods of static posture, and the long time use of microscopes and magnifiers lead the microsurgeons in a particularly high risk to the pain mentioned above.
In this project, we are focusing on the surgeon posture during ear surgery. There are two kinds of surgical sceneries: traditional case and endoscopic case. When surgeons do ear surgery in a traditional way, they have to look through microscopes. It is obvious that surgeons have to band their necks, and even sometimes they need to band over their bodies in order to finish specific operations. The persistent neck flexion is the main factor that causes the discomfort. However, as for endoscopic cases, surgeons can make full use of the monitors. It is easier for them to keep the correct upright posture for most of the time.
Poor surgical ergonomics may lead to surgeon disability:
It is crucial and meaningful for us to investigate:
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We hypothesize that neck flexion angle is greater than 30 degrees for a higher proportion of time during traditional open surgery, such as microscopic ear surgery, than during minimally invasive endoscopic surgery, such as endoscopic ear surgery.
For this study, the software and the surgical simulation environments for data collection was arranged. In order to confirm the accuracy of neck flexion measurements, the IMUs’ pitch angle was calibrated against a known angle measured by an electromagnetic tracker (EM tracker), and a linear regression model is used to derive the calibration.
Next, the mathematical model for pitch angle calculation was derived using quaternion and rotation matrices. The quaternions of the IMUs were collected for both the reference posture (standing normally and neutrally for one minute) and in the operating posture. We converted the quaternions to Euler angles in order to calibrate the pitch component using the linear regression model mentioned above. Then, the calibrated Euler angles were converted into rotation matrices. For both IMUs, we calculated the difference rotation matrices between the reference position data and the surgical position data. Finally, the difference rotation matrix between the two IMUs was calculated and converted into Euler angles with X, Y, and Z components. The X component, or the pitch angle, was the neck flexion angle of our interest.
We collected data for seven head movements, including turning the head in the X, Y and Z planes periodically, rotating the head in all directions, and shaking the shoulders to confirm the rationality of our algorithm. We then performed mock surgical procedures in a simulated operating room setting. Two surgical scenarios were simulated in order to compare traditional surgery with endoscopic surgery.
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