Ergonomic Trends in Endoscopic Skull-Base Surgeons: A Survey to the North American Skull Base Society

Authors

• Shreya Mandloi, Thomas Jefferson UniversityFollow
• Alexander Duffy, Thomas Jefferson UniversityFollow
• Praneet C. Kaki, Thomas Jefferson UniversityFollow
• Elina Toskala, Thomas Jefferson UniversityFollow
• Marc Rosen, Thomas Jefferson UniversityFollow
• Christopher Farrell, Thomas Jefferson UniversityFollow
• James J. Evans, Thomas Jefferson UniversityFollow
• Gurston G. Nyquist, Thomas Jefferson UniversityFollow
• Mindy R. Rabinowitz, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

3-9-2026

Comments

This article is the author’s final published version in OTO Open, Volume 10, Issue 1, 2026, Article number e70220.

The published version is available at https://doi.org/10.1002/oto2.70220. Copyright © 2026 The Author(s).

Abstract

OBJECTIVE: Lack of ergonomic practices in the operating room results in significant musculoskeletal strain. This study obtains a current assessment of self-reported musculoskeletal strain associated with endoscopic endonasal and open skull base surgery as reported by members of the North American Skull Base Society (NASBS).

STUDY DESIGN: Online Survey.

SETTING: Online.

METHODS: A survey assessing current symptoms in endoscopic skull base surgery was distributed to members of the NASBS.

RESULTS: Sixty‐six responses were completed and analyzed. 95% of respondents indicated they had musculoskeletal strain at the neck and C‐spine. There was no significant difference in average operating time per week and musculoskeletal strain. Prolonged standing during endoscopic cases increased neck/C‐spine musculoskeletal strain (OR: 3.96; CI: 1.26, 14.2; P = .024). Dominant hand, operating with 1 versus multiple gloves, switching holding the endoscope with other physicians, foot pedal position, monitor, position, and manipulation of endoscopic instruments did not impact musculoskeletal strain (P > .05). Endoscopic endonasal skull base surgeons (EESBs) that operate on the same side of the table had significantly less L‐spine pain than EESBs that operate on the opposite side of the table (OR: 0.25; CI: 0.07, 0.82; P = .026).

CONCLUSION: The results found that most respondents experience musculoskeletal strain and that factors including surgeon positioning and prolonged standing increase pain. Altering strategies in the operating room, including surgeon and instrument positioning, may help to decrease ergonomic strain amongst skull base surgeons.

Recommended Citation

Mandloi, Shreya; Duffy, Alexander; Kaki, Praneet C.; Toskala, Elina; Rosen, Marc; Farrell, Christopher; Evans, James J.; Nyquist, Gurston G.; and Rabinowitz, Mindy R., "Ergonomic Trends in Endoscopic Skull-Base Surgeons: A Survey to the North American Skull Base Society" (2026). Department of Otolaryngology - Head and Neck Surgery Faculty Papers. Paper 110.
https://jdc.jefferson.edu/otofp/110

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

41809139

Language

English