Prospective Evaluation of Surgical Ergonomics Among Endocrine Surgeons in Open Thyroidectomy: A Pilot Study

Surgeons performing open thyroidectomy are prone to ergonomic strain due to head-mounted lighting, prolonged static posture, and repetitive fine-motor activity. Limited objective data exist on ergonomic stress in endocrine surgery.

This prospective observational pilot study was conducted in a tertiary endocrine surgery department. Thirty-two open hemithyroidectomy cases were evaluated. Surgeons were divided into operating and assistant cohorts. Pre- and post-operative assessments included salivary biomarkers (AST, CK, LDH), hand grip strength, and Rapid Upper Limb Assessment (RULA) scoring.

Operating surgeons demonstrated significant rises in salivary CK (3.5 → 11 U/L), AST (3.8 → 15 U/L), and LDH (102 → 370 U/L) (all p < 0.001), with a modest, non-significant decline in grip strength. Assistant surgeons showed significant increases in CK (4.9 → 16.85 U/L) and AST (19 → 32.8 U/L), a slight reduction in LDH, and a significant improvement in grip strength (201 → 535.5 N, p < 0.001). RULA scores indicated greater ergonomic strain in operating surgeons (median 4) compared to assistants (median 3, p < 0.001).

Open thyroidectomy imposes considerable ergonomic and physiological stress, with operating surgeons bearing higher strain from static posture and awkward positioning. Assistant surgeons experience different but measurable patterns of muscular activation. This study highlights the feasibility of combining salivary biomarkers, grip strength, and RULA scoring for ergonomic assessment and emphasizes the need for ergonomic awareness in surgical training.