OBJECTIVES

: To evaluate the available evidence regarding ergonomics with a heads-up setup and digitally assisted vitreo-retinal surgery (DAVS) compared to conventional microscopy.

METHODS

: A systematic literature review was conducted in PubMed and EMBASE. A search for English studies published between 2009-2019 using comprehensive search terms pertaining to retinal surgery ("Ophthalmologic Surgical Procedures"), 3D heads-up visualization (“3D Visualization”, "Ophthalmoscopes", “heads up display”, “heads up surgery”), and health economics/outcomes research was performed in PubMed. Additional targeted searches were performed in EMBASE. Two independent reviewers scored 302 abstracts in total and identified 4 full-text papers that evaluated ergonomic outcomes.

RESULTS

: Studies by Eckardt et al. (2016), Zhang et al. (2018), Palácios et al. (2019), and Rizzo et al. (2018) suggest that heads-up displays provide improved surgical ergonomics and comfort for the primary surgeon. Eckardt et al., Zhang et al., and Palácios et al. asked users to rate the general ergonomics of DAVS via a subjective questionnaire and all three studies demonstrated that DAVS was associated with statistically significantly higher ergonomic ratings than conventional microscopes. Additionally, Rizzo et al. asked the primary surgeon about their neck and back pain post-surgery, and asked the second surgeon, the anesthetist, and operating room nurses about their comfort during surgery. While most responded positively in favor of DAVS, secondary surgeons expressed dissatisfaction in having to rotate their head to view the screen. This rotation is likely due to screen placement which is optimally located for the primary surgeon, but not for the secondary surgeon.

CONCLUSIONS

: While literature on DAVS and its potential ergonomic benefits is limited, all published data in this area suggests improved general ergonomics for primary surgeons with DAVS versus conventional microscopes. Future studies utilizing more objective measures of ergonomics are warranted. Additionally, potential ways for improving DAVS ergonomics for the secondary surgeon should be sought.