title: Ergonomics in endoscopic sinus surgery: systematic review of the literature.
abstract: OBJECTIVE
  To conduct a systematic review of reports on the ergonomic posture of the surgeon during endoscopic sinus surgery.
  
  
  METHODS
  Literature review.
  
  
  METHODS
  Systematic review of the French- and English-language literature using PubMed from January 1970 to March 2004. Articles were divided into four categories: visualization through an endoscope or a videoendoscope, monitor position, sitting or standing position, and arm support.
  
  
  RESULTS
  Endoscopic sinus surgery with direct vision through the endoscope is associated with faulty neck positioning and does not appear to bring any advantages in terms of surgical performance compared with vision via a video monitor. Low back pain and lower extremity complaints are commonly associated with the standing position. Spinal flexion seems more harmful than a straight posture. The preferred viewing angle for video monitors is a few degrees below the horizontal gaze line. An arm support can be beneficial because it is associated with minimization of neck, shoulder, and lumbar stress.
  
  
  CONCLUSIONS
  We recommend (1) visualization via a television monitor instead of direct vision through an endoscope, (2) positioning the screen in direct axis with the surgeon's body and a few degrees below the horizontal line of gaze, (3) surgery in the seated position instead of the standing position, and (4) the use of an elbow support for the arm holding the endoscope.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, QC.
authors.forename: Tareck
authors.initials: T
authors.lastname: Ayad
authors.forename: Louis
authors.initials: L
authors.lastname: Péloquin
authors.forename: François
authors.initials: F
authors.lastname: Prince
mesh_terms: D019723:Endoscopes; D004724:Endoscopy / Q000379:methods* / Q000592:standards; D006804:Ergonomics; D006801:Humans; D010256:Paranasal Sinuses / Q000601:surgery*; D011187:Posture; D011597:Psychomotor Performance; D039781:PubMed; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods*