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Evaluation of visual ergonomics in microsurgery: a real-time video processing solution.

Gaukhar Mukash¹, Paavo Vartianen², Mastaneh Torkamani-Azar³

¹Department of Technical Physics, Faculty of Science, Forestry and Technology, University of Eastern Finland, Kuopio, 70211, Finland. gmukash@uef.fi.

Acta Neurochirurgica

|November 5, 2025

Summary

Microsurgeons face visual challenges like obstructed views and loss of context. Novel assistive technologies, such as context-preserving magnification and instrument transparency, show promise in improving surgical ergonomics and efficiency.

Keywords:

Image-guided surgery Instrument transparency Microsurgery Minimally invasive surgery Surgical microscope

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Area of Science:

Surgical Technology
Medical Ergonomics
Microsurgery

Background:

Microsurgeons experience persistent visual and ergonomic challenges with traditional surgical microscopes, particularly concerning narrow visual fields during high-magnification procedures.
Existing microscope technology improvements have not fully resolved issues like instrument obstruction and loss of visual context, impacting surgical performance and surgeon comfort.

Purpose of the Study:

To identify and characterize the specific visual ergonomics challenges faced by microsurgeons during high-magnification procedures.
To assess the need for and potential benefits of novel assistive surgical solutions designed to overcome these limitations.

Main Methods:

A two-part study involving surveys and hands-on experiments with neurosurgery and otolaryngology (ENT) specialists.
Semi-structured interviews were conducted to gather qualitative data on challenges, followed by a Likert scale survey evaluating two proposed solutions: context-preserving magnification (CPM) and instrument transparency (IT).
A hands-on experiment with practicing neurosurgeons compared task performance using a novel solution against a standard operative microscope.

Main Results:

Key challenges reported include instrument visual field obstruction (93.75%), blurring (81.25%), and loss of context (68.75%).
50% of surgeons found adjusting zoom/focus time-consuming, and 56% reported depth perception difficulties.
Hands-on trials showed potential benefits, with CPM reducing task completion time by 40% for 60% of participants, and 69% expressed interest in testing prototypes.

Conclusions:

Novel assistive technologies, particularly those offering wider visual fields and instrument transparency, are highly desired by microsurgeons to address persistent visual challenges.
The study indicates a strong likelihood of adoption for new technologies that mitigate instrument obstruction and enhance visual ergonomics in high-magnification microsurgery.