Comparing the Ergonomic Aspects of the Exoscope and Microscope in Neurosurgery Using Motion Sensors

Ergonomic improvement for neurosurgeons is essential in reducing musculoskeletal disorders, particularly during prolonged procedures. Traditional microscopes often limit the range of motion, forcing surgeons into uncomfortable positions, particularly in cases involving angulated or narrow anatomy. This study compares neurosurgeons' posture and handling of the exoscope versus the microscope evaluating its ergonomic aspects. 26 cases were operated using a microscope (Zeiss, Jena, Germany) and 29 using an exoscope (Olympus, Tokyo, Japan). Data included task load index, camera and ocular adjustments, as well as subjective and objective assessments of posture. Sensor-based movement measurements were available for 18 cases, of which 8 were operated using the exoscope and were used to evaluate the surgeon's neck posture. The task load index showed lower means when using the exoscope without significant differences. Camera adjustments were, on average, more frequent when using the exoscope (35.6 vs 26.9; p=0.153). Subjective assessment indicated better body reclination and lateral bending posture with the exoscope (p<0.001). Sensor data revealed angles of neck inclination, reclination, and lateral bending mostly below 20° across both modalities, without statistically significant differences. The exoscope group reported lower fatigue scores and subjectively milder body posture angles, suggesting ergonomic benefits, with no significant differences in the measured neck posture. The higher frequency of camera adjustments with the exoscope, combined with lower fatigue scores, highlights its potential ergonomic advantages due to increased range of motion, which are likely to improve further with ongoing technical refinements and growing user experience. • Exoscope use significantly improved body posture according to subjective ratings. • Exoscope use reduced the physical demand and fatigue. • Cervical inclination, reclination and lateral bending were largely comparable across modalities, with most measurements remaining below 20°.