A comparative analysis of ergonomic risk utilizing the 4K-3D exoscope versus standard operating microscope for male fertility microsurgery.

To stratify ergonomic risk in a urologic microsurgeon using the 4K-3D exoscope versus the operating microscope (OM) with wearable technology.

The surgeon was calibrated with wearable sensor inertial measurement units (IMUs) on the head and upper arms.


Each IMU contained an accelerometer, magnetometer, and gyroscope to measure surgeon joint angle change during microscopic procedures for male fertility. The validated modified rapid upper limb assessment was used to determine the proportion of time spent in ranges of risk. Categories 1-4 were assigned for the head and upper extremities (4= highest ergonomic risk). Chi-squared analysis was used to analyze differences in proportions.

A total of 500 and 479 minutes from 4K-3D exoscope and OM guided surgeries were analyzed. The 4K-3D exoscope significantly favored upper arm category 1 positioning compared to the OM (56.2% vs. 37.7%; p < 0.0001). The OM exposed the surgeon to higher category 3 positioning (14.6% vs. 1.6%; p <0.0001). More time was spent with the neck "extended" using the 4K-3D exoscope (51.8% vs. 19.5%; p < 0.0001) with 67% of neck extension between 0-10 degrees (category 1). Overall, more time was spent with the neck in risk group 1-2 with the OM (p < 0.0001).

The 4K-3D exoscope offers favorable ergonomic positioning for the upper extremities which may reduce work stress-related injury. More operative time was spent with the neck in mild extension with 4K-3D exoscope utilization. However, the operating microscope favored longer operative times in low-risk neck ergonomic positions.

Urology. 2022 Nov 30 [Epub ahead of print]

Rohit Reddy, Kevin Chu, Nicholas A Deebel, Jesse Ory, Alexander Weber, Ryan Terlecki, Ranjith Ramasamy

Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136. Electronic address: ., Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136. Electronic address: ., Department of Urology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157. Electronic address: ., Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136. Electronic address: ., Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136. Electronic address: ., Department of Urology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157. Electronic address: ., Desai Sethi Urological Institute, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136. Electronic address: .

Go Beyond the Abstract and Read a Commentary by the Author