Impact of a neck exoskeleton device on plastic surgery resident ergonomics

Plastic surgery residents are at high risk for work-related musculoskeletal discomfort. We hypothesize that resident postural ergonomics are poor and it may improve with the use of a passive exoskeleton device.

Plastic surgery residents wore inertial measurement units to objectively record intraoperative posture during breast cases, at baseline and while using an exoskeleton. Pre- and postoperative surveys evaluated discomfort, fatigue, and usability.

Ten residents (70% men, mean post-graduate level (PGY) 3) completed 39 operative cases. Cases included breast implant procedures (n=33) and chest vessel exposure (n=6) via inframammary fold incisions, including 18 exoskeleton cases. Exoskeleton use did not increase operative duration (119 baseline vs. 101 exoskeleton min; p=0.25), NASA-TLX task load index scores, or perceived case difficulty. Subjective data suggest that the cumulative change in discomfort for the measured body parts was not impacted by the exoskeletons. Objective data showed a significant reduction in the mean neck flexion angle (25.8° vs. 32.8°, p=0.01) and significant reduction in neck risk scores indicating shorter duration in high-risk positions (2.5 vs. 2.7, p=0.03). Neck risk scores (0-4 scale) were significantly worse during chest vessel exposure versus implant cases (2.85 vs. 2.54; p=0.004). No significant differences were noted between PGY level. On a 5-point scale, residents indicated little discomfort using the exoskeleton (1.5) and high likelihood of using a future posture correcting device (3.4). On a 10-point scale, residents indicated limited exoskeleton interference with the ability to operate (2.8) and minimal range of motion limitation (3.3). Interest in future exoskeleton use was reported after 12 (67%) cases.