Ergonomic burden in microsurgery: Real-time quantification of cervical posture using biosensor technology

Reconstructive microsurgeons are prone to musculoskeletal strain due to prolonged static postures and use of magnification. This study prospectively quantified intra-operative cervical posture, assessed the prevalence of neck pain and identified factors associated with ergonomic strain.

Eleven reconstructive microsurgeons were prospectively recruited between July and December 2024. The lead surgeon wore an Upright GO 2™ posture sensor to measure the proportion of operative time spent in cervical flexion >30° during (a) flap raise and (b) micro-anastomosis. Participants completed validated questionnaires assessing musculoskeletal symptoms (NMQ-E), neck disability (NDI), resilience (BRS) and a structured risk-factor survey.

Across 25 free-flap procedures, surgeons spent 88.5 ± 8.5% of flap-raise time in flexion >30°, compared with 3.9 ± 7.0% during micro-anastomosis (p < 0.001). Surgeon height independently predicted cervical flexion during both phases (β = +0.008, p = 0.009; β = -0.006, p = 0.005). More than half of the participants (54.5%) reported neck pain within the previous 12 months, associated with impaired sleep and reduced recreation. Longer weekly microsurgical exposure correlated with greater time in excessive flexion during flap raise (ρ = 0.439, p = 0.019), while higher sedentary time correlated with flexion during micro-anastomosis (ρ = 0.416, p = 0.025).

Cervical loading during microsurgery is substantial, particularly during flap raise. Ergonomic strain reflects the interplay between posture, surgeon anthropometry, and lifestyle factors. Targeted ergonomic interventions and prospective interventional studies are warranted to promote musculoskeletal health and sustain operative performance in microsurgeons.