Neck ergonomics in rhinology surgeons: the impact of refractive surgical loupes

Background: Work-related musculoskeletal disorders (WMSDs) are common among surgeons, with rhinology surgeons particularly affected by sustained cervical flexion often employed during surgical procedures. Refractive surgical loupes are designed to redirect the surgeon’s visual axis to facilitate a more neutral neck position. Objective quantitative data supporting their use remain limited. This study assessed the association of refractive surgical loupes with craniovertebral angle (CVA) during routine rhinology procedures.

Methods: This prospective repeated measures observational study was performed by ten surgeons and Fellows of the Royal Australasian College of Surgeons (FRACS). Each surgeon performed the same procedure with and without refractive loupes (each surgeon acted as their own control). Sagittal plane footage was captured at a fixed distance and analysed at 0.1-second intervals using video analytic software (Kinovea) to quantify CVAs. Measurements demonstrating rotation or lateral deviation were excluded. The mean CVAs for each surgeon with and without refractive loupes were compared using paired t-tests.

Results: The mean CVA between standard and refractive loupes was compared across 10 surgeons. Use of refractive loupes was associated with a statistically significant increase in CVA, with a mean improvement of 21.4 degrees [95% confidence interval (CI): 14.1–28.7; P<0.001]. All surgeons demonstrated reduced cervical flexion when using refractive loupes compared with standard loupes.

Conclusions: Refractive surgical loupes substantially improve the surgeon’s posture by increasing the CVA during rhinology surgery. Given the use of CVA as a surrogate marker and predictive factor for neck pain, this simple ergonomic intervention may reduce cervical strain and contribute to the long-term mitigation of WRMDs. Further longitudinal research is required to determine whether the changes translate into measurable reductions in work-related musculoskeletal disorders.