From Surgical Precision to Physical Pain: How Aesculap Aeos® is Revolutionising Surgical Ergonomics for Plastic Surgeons

A Day in Theatre

Imagine beginning your day at 7:30 AM, neck already bent at a 45-degree angle, eyes straining through magnification loupes, hands suspended in microsurgical precision for the next six hours. By mid-afternoon, that familiar burning sensation crawls across your upper trapezius. By evening, it's a dull, persistent ache extending from your cervical spine to your shoulders.

This isn't an uncommon day—it's the routine reality for plastic surgeons worldwide.

The Evidence: A Growing Crisis

The data tells a sobering story: over 80% of surgeons suffer from Work-Related Musculoskeletal (MSK) disorders, accounting for 40% of NHS sickness absences (1-3). For plastic surgeons, this crisis reaches concerning proportions:

• Prevalence: 70% report MSK symptoms post-surgery, primarily in the neck, back, and shoulders (4)
• Performance Impact: Nearly 1 in 5 admit these symptoms compromise their surgical precision (4)
• Career Implications: UK data shows 67 of 329 plastic surgeons required sick leave for MSK disorders, many with multiple episodes (5)

A compelling pattern emerges across international research spanning the United States, United Kingdom, and India (4–7). Plastic surgeons face a significantly higher risk of developing MSK conditions than both the general population (8) and surgeons in other specialties (7).

The Critical Threshold

Research highlights a critical correlation: surgeons operating with loupe magnification for more than 15 hours weekly, experience significantly greater cervical MSK symptoms (5). Yet a recent survey reveals plastic surgeons average 22 hours of weekly surgery (9)—far exceeding this threshold.

It’s therefore unsurprising that 77% report pain while using traditional microscopes, with free flap procedures identified as particularly problematic (9).

The Biomechanical Perfect Storm

What makes plastic surgery uniquely hazardous to musculoskeletal health? Three interrelated factors create what could be termed a "biomechanical perfect storm":
 

1. Extreme Positional Demands
   Measurements reveal surgeons maintain neck flexion exceeding safe thresholds for 85% of operating time (10). At just 30 degrees beyond neutral—common during microsurgery—the weight experienced by the cervical spine quadruples, creating a relative risk greater than 2.0 for developing neck pain (11,12).
   
   
2. Microsurgical Immobility
   The microsurgical precision demanded in plastic surgery requires near-complete immobility. While normal individuals make approximately 5.5 movements per minute at rest, surgeons make just 0.3 movements during microsurgical procedures (13)—a 95% reduction in natural movement patterns.
   
   
3. Equipment-Induced Loading
   Loupe magnification increases cervical loading by 40% (14). Add headlamps, and over 80% of surgeons report neck symptoms, creating cumulative stressors that compound throughout a career (13,14).

The Healthcare Impact

These statistics translate to tangible healthcare costs: 14-27 lost working days per MSK episode among plastic surgeons (5)—a substantial burden on an already strained system, not to mention the personal and professional implications for surgeons themselves.

The Heads-Up Solutions: A Technological Breakthrough

Heads-up 3D microscopy represents a significant technological advancement that directly addresses the ergonomic challenges inherent in microsurgery (15). Initially adopted in ophthalmology (16), this approach has demonstrated remarkable benefits without compromising image quality or technical feasibility (17). By allowing surgeons to operate while maintaining a neutral, upright posture, heads-up systems fundamentally transform the biomechanical experience of microsurgery.

The core principles behind heads-up microscopy—improved ergonomics, enhanced visualisation, and reduced physical strain—represent exactly the kind of innovation needed to address the MSK epidemic among plastic surgeons.

The Aesculap Aeos® Revolution

Within the emerging field of heads-up microscope, the Aesculap Aeos® 3D Robotic-Assisted Digital Surgical Microscope represents one compelling option. The Aesculap Aeos® technology utilises advanced display capabilities to eliminate the need for physically demanding postures. Surgeons can maintain a neutral, upright position throughout procedures, reducing the strain on the neck, back, and shoulders that has been documented in the literature (15,18).

Beyond ergonomics, the Aesculap Aeos® system offers:

• Superior visualisation technology with exceptional depth perception capabilities (19,20)
• Powerful backlight illumination systems that aim to reduce eye strain (20)
• Collaborative viewing options that allow team-based approached to microsurgery (21)
• Reduced procedure times contributing to procedural efficiency (18,22,23)

As one of several technological options becoming available to plastic surgeons, the Aesculap Aeos® system exemplifies how digital visualisation technology is evolving to address long-standing ergonomic challenges in microsurgery.

A Career-Preserving Investment

Aesculap Aeos® represents far more than a technological upgrade—it's an investment in preserving surgical expertise and reducing workforce depletion. When factoring in the costs of sick leave, reduced productivity, and potential early retirement of skilled surgeons, the economic case becomes compelling.

For surgeons themselves, this technology offers a transformative possibility: the opportunity to practice their craft at the highest level without sacrificing physical wellbeing. 

Beyond Innovation to Necessity

As the understanding of surgical ergonomics evolves, it’s becoming clear that technologies like the Aesculap Aeos® aren't merely innovative options—they're becoming essential safeguards for surgical careers and expertise.

In an era of increasing healthcare demands and workforce challenges, addressing the silent epidemic of MSK disorders (3) isn't optional—it's imperative for the future of plastic surgery.

For more information

Please visit: Aesculap Aeos® for Plastics - B. Braun

Please contact: Verena Vogel verena1.vogel@bbraun.com +447977538052

Author: Amelia Deacon, Associate Medical Science and Commercial Value Liaison, B. Braun Medical Ltd.