Posture and ergonomics of the cervical spine in vitroretinal surgery, a comparative study between 3D heads-up versus surgical microscope

Abstract

Purpose : Spinal conditions are one of the main causes of early retirement in ophthalmologists, so new surgical visualization technologies seek to address this problem by promising better posture during surgery, however they have never been compared to the surgical microscope.
Our purposes were to compare the total time for vitreoretinal surgery with an ergonomically desirable position, the craniovertebral angle (CVA) and the gaze angle (GA) between Heads-up 3D and the use of a surgical microscope.
We performed a prospective, longitudinal, comparative, randomized study to learn which equipment gave the best posture and greatest time in an ergonomically desirable position.

Methods : We studied 4 experienced retina-vitreous surgeons, in a total of 80 retinal surgeries regardless of the type of procedure, 40 in Heads-up and 40 in the surgical microscope.
The photometry method was standardized for measuring CVA and GA, which are values that represent the position of the head using anatomical points as reference. Likewise, using the Upright Go equipment (sensor accelerometer, gyroscope & magnetometer) the ergonomic posture was measured in time during surgery.
Independent sample T Test was made to analyze the data. We compared first the two equipments and then we divided the surgeons in two groups < 40 years old and > 40 years old.

Results : We first analyzed the normal and abnormal posture time. In the surgical microscope we observed that of an average of 76.88±29.28 minutes that the surgery lasted, the surgeons on average had a time in abnormal posture of 55.25±31.71 compared to the 3D Heads-up the average surgical time was 79.92±35.83 minutes of which 65.17±35.01 minutes were in abnormal posture (p 0.188) and only in the microscope there was a normal posture on average of 21.60±34.73 minutes compared to Heads-up 3D which obtained 14.60±19.06 minutes (p 0.268). Given these results, each equipment was analyzed among the groups of surgeons where similar results are observed. This can be seen in the attached tables. When comparing the values of CVA and GA obtained during surgery in both equipment, we observed that neither of the two equipment provided values within normality throughout the surgical time.

Conclusions : Although our study had standardized measurements, N of 80 patients, and a control for possible confounders, we cannot rule out the presence of bias.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.