Ergonomically Designed Surgical Microscopes Support Performance


Operations not only demand maximum concentration of the surgeon but also maximum physical fitness. Physiotherapist John Ludescher explains how the body can be given optimal support to perform at its best. The Austrian qualified as physiotherapist in Switzerland and has had his own practice for nine years. He is the author of the book “Aufrecht – Bewusst – Stark” (Upright – Aware – Strong) and designer of the “PhysioCap”.

Mr. Ludescher, which parts of a surgeon’s body are subject to particular strain when operating with a microscope?

Mainly the cervical spine, the cervicothoracal junction and the shoulder and neck muscles. The strain manifests itself in symptoms such as tenseness and pain in the shoulder muscles that may radiate into the arms, slipped discs, headaches, tinnitus symptoms and general states of exhaustion.

The frequently observed anteroposition of the head also has a negative effect. This leads to an unfavourable position of the first cervical vertebra C0/1, which not only affects the structures in the jugular foramen, but also creates stress in the craniomandibular system.

Hyperextension of the wrists causes asymmetrical strain on the lower arm muscles, which can result in tendon sheath pain and the so-called “tennis elbow”.

Fig. right: John Ludescher demonstrates the optimal position: “The body should be in a perpendicular line, i.e. ear, shoulder joint and hip joint have to be in vertical alignment.”

These postures lead to symptoms such as tenseness and pain in the shoulder muscles that may radiate into the arms, slipped discs and headaches.

What does an ergonomically ideal workplace in the operating room look like?

Ideally, the chairs for surgeons and assistant should be small, manœuvrable and comfortable besides having adequate adjustment options. They should also be compatible with the operating table. The microscope should be easy and quick to control, have a memory function if possible, and be adaptable to all sizes of surgeons. Only then can the operating team adopt working postures that are ergonomic and resource-saving in the long term.

The body should be in a perpendicular line, i.e. ear, shoulder joint and hip joint have to be in vertical alignment. The first step towards achieving this is to make sure the surgeon’s chair is properly adjusted: In a sitting position, the surgeon’s hip joint should be at an angle of greater than 90 degrees to the upper part of the body. Also, the hip joints should be higher than the knee joints to be able to bend both legs at right angles. This straightens the position of the pelvis, making sitting less tiring. The muscles are in a neutral position and strain is avoided. Finally, when adjusting the inclination of the seat it is important that the pressure of the seat is evenly distributed to the thighs. In a second step, the operating table has to be set at the right height and the right working distance between the chair and the table must be observed.

After these adjustments have been carried out, it’s time for the third step: the surgeon adjusts the position of the microscope to enable him to maintain an upright posture: Depending on his girth and size, the viewing height and angle of the objective and binocular tube have to be adjusted until the surgeon can work in a comfortable upright posture and with the correct working distance to the operating area. Of course, this is only possible with a microscope system featuring variable binocular tubes and flexible accessories. They should also be easy to handle, as in many operating rooms several surgeons use the same microscope in succession. In this respect, Leica Micro systems provides a pioneering portfolio of products.

That is the best case scenario. And what is everyday reality for a surgeon?

Most surgeons sit down first and then adjust their posture to the microscope, which inevitably leads to posture errors and the types of pain I described.

I have often also heard the objection that eye operations only take about ten minutes, so ergonomics are not a major issue. But a large number of short operations ultimately add up to a long working day spent at the microscope. Apart from this, many surgeons don’t make the most of the facilities the microscope has to offer. They use it to see better without being aware of its ergonomic features.

What else can surgeons do to counteract physical strain at the operating table?

Extremely important, of course, is physical fitness, a healthy lifestyle and awareness of the body. Because to bring his body into the perpendicular line necessary for relaxed sitting and working, a doctor has to know how it feels when he or she is in equilibrium. After all, he can’t have a look at himself in a mirror first!

The PhysioCap I designed is useful for this. It’s a baseball cap with a silicone insert weighing 500 grams. It gives you the feeling you’re balancing a book on your head. This cap trains and conditions the neck and spine muscles and encourages the body to automatically assume a good upright posture. With time, a correct posture is “programmed”.

Even the best surgeon can only deliver good results if he offers his body, of which he demands a great deal, optimum conditions. An upright, comfortable posture improves concentration and the quality of work – and makes the surgeon feel less exhausted at the end of the day. After all, even a surgeon’s day doesn’t end when he leaves the operating room.

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