Fig. 2.

Traditional heads-down microscopic surgery is associated with unfavorable ergonomics. Arrows illustrate the posture of the surgeon and the corresponding line of sight when using each device. (A) Binocular microscopy, even with armrests, Trendelenburg positioning, and 250-mm focal length places strain on the neck, shoulders and back during prolonged dissection. The stack height of the microscope increases the distance between the end of the oculars to the ear, requiring outstretched arms. (B) Heads-up exoscopic surgery results in a relaxed posture and enhanced body mechanics.

(Adapted from Smith S, Kozin ED, Kanumuri V V., et al. Initial Experience with 3-Dimensional Exoscope-Assisted Transmastoid and Lateral Skull Base Surgery. Otolaryngol - Head Neck Surg (United States). 2019; with permission.)