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Impact of Ergonomic Interventions in Cleft Palate Surgery: A Cross-Sectional Analytical Study Assessing Surgeon Performance and Perceived Patient Outcomes

Abdur Rehman Akhtar Warriach1, Husnain Khan2, Sundas Shafique3, Javeria Arshad Kiany4, Sania Khalid4
1PGT Rawalpindi burn and reconstructive surgery department, Holy Family Hospital Rawalpindi
2HOD Rawalpindi Burn and Reconstructive Surgery department, Holy Family Hospital, Rawalpindi, Pakistan
3PGT Department of Paediatric Surgery, Holy Family Hospital, Rawalpindi, Pakistan
4PGT Rawalpindi Burn and Reconstructive Surgery Department, Holy Family Hospital, Rawalpindi, Pakistan
DOI: https://doi.org/10.70517/revcc2624138
Published: 07/10/2026
: Abdur Rehman Akhtar Warriach, Husnain Khan, Sundas Shafique, Javeria Arshad Kiany, Sania Khalid. Impact of Ergonomic Interventions in Cleft Palate Surgery: A Cross-Sectional Analytical Study Assessing Surgeon Performance and Perceived Patient Outcomes. Revista Cultura Científica, 2026 Issue 24. pg. 1667-1675.

Abstract

Cleft palate surgery requires prolonged concentration, precise visualization, sustained fine-motor control, and maintenance of operative posture, all of which may expose surgeons to ergonomic strain and musculoskeletal discomfort. This study assessed ergonomic practices, fatigue, musculoskeletal discomfort, and the perceived effects of ergonomic interventions on surgical performance and patient-related outcomes among cleft palate surgeons. This cross-sectional analytical study included 75 cleft palate surgeons from Plastic Surgery, ENT, and Pediatric Surgery departments at RMH Allied Hospitals between May 2026 and August 2026. Participants were selected using stratified random sampling. The mean age of the surgeons was 38.7 ± 7.9 years, and their mean surgical experience was 11.6 ± 6.8 years. Regular ergonomic interventions were used by 51 (68.0%) surgeons. Headlights were the most frequently used intervention (57, 76.0%), followed by Galilean loupes (43, 57.3%), operating microscopes (29, 38.7%), and prismatic ergonomic loupes (24, 32.0%). The mean fatigue score was 6.1 ± 2.0, while musculoskeletal discomfort was reported by 48 (64.0%) surgeons. Neck discomfort was the most common complaint (36, 48.0%), followed by lower-back discomfort (29, 38.7%) and shoulder discomfort (25, 33.3%). Ergonomic factors were considered a contributor to fatigue by 46 (61.3%) surgeons. Ergonomic practices were perceived to reduce intraoperative errors by 54 (72.0%) surgeons, decrease operative time by 47 (62.7%), reduce complications by 42 (56.0%), and improve postoperative recovery by 45 (60.0%). Overall, 68 (90.7%) surgeons supported incorporating ergonomics into cleft-surgery training. These findings indicate that ergonomic challenges and musculoskeletal discomfort are common among cleft palate surgeons despite substantial use of ergonomic interventions. Structured ergonomic education, appropriate visualization equipment, improved operative positioning, and objective assessment of posture may help reduce occupational strain and support surgical performance. Because the performance and patient-related outcomes were self-reported perceptions in a cross-sectional study, they should not be interpreted as proof of causal improvement in patient outcomes.

Keywords: cleft palate surgery, surgical ergonomics, musculoskeletal discomfort, surgeon fatigue, ergonomic practices, surgical performance

Abstract

Cleft palate surgery requires prolonged concentration, precise visualization, sustained fine-motor control, and maintenance of operative posture, all of which may expose surgeons to ergonomic strain and musculoskeletal discomfort. This study assessed ergonomic practices, fatigue, musculoskeletal discomfort, and the perceived effects of ergonomic interventions on surgical performance and patient-related outcomes among cleft palate surgeons. This cross-sectional analytical study included 75 cleft palate surgeons from Plastic Surgery, ENT, and Pediatric Surgery departments at RMH Allied Hospitals between May 2026 and August 2026. Participants were selected using stratified random sampling. The mean age of the surgeons was 38.7 ± 7.9 years, and their mean surgical experience was 11.6 ± 6.8 years. Regular ergonomic interventions were used by 51 (68.0%) surgeons. Headlights were the most frequently used intervention (57, 76.0%), followed by Galilean loupes (43, 57.3%), operating microscopes (29, 38.7%), and prismatic ergonomic loupes (24, 32.0%). The mean fatigue score was 6.1 ± 2.0, while musculoskeletal discomfort was reported by 48 (64.0%) surgeons. Neck discomfort was the most common complaint (36, 48.0%), followed by lower-back discomfort (29, 38.7%) and shoulder discomfort (25, 33.3%). Ergonomic factors were considered a contributor to fatigue by 46 (61.3%) surgeons. Ergonomic practices were perceived to reduce intraoperative errors by 54 (72.0%) surgeons, decrease operative time by 47 (62.7%), reduce complications by 42 (56.0%), and improve postoperative recovery by 45 (60.0%). Overall, 68 (90.7%) surgeons supported incorporating ergonomics into cleft-surgery training. These findings indicate that ergonomic challenges and musculoskeletal discomfort are common among cleft palate surgeons despite substantial use of ergonomic interventions. Structured ergonomic education, appropriate visualization equipment, improved operative positioning, and objective assessment of posture may help reduce occupational strain and support surgical performance. Because the performance and patient-related outcomes were self-reported perceptions in a cross-sectional study, they should not be interpreted as proof of causal improvement in patient outcomes.

Keywords: cleft palate surgery, surgical ergonomics, musculoskeletal discomfort, surgeon fatigue, ergonomic practices, surgical performance

References

  1. LaMonica, Lauren C., et al. “Musculoskeletal Disorders Among Surgeons and Attitudes Towards Wearable Devices for Ergonomic Optimization.” Annals of Surgery, vol. 283, no. 6, 2026, pp. 950–958.

  2. Marathe, Aditya B., et al. “Work-Related Musculoskeletal Disorders among Practicing Plastic Surgeons in India: A Cross-Sectional Survey.” Indian Journal of Plastic Surgery, vol. 58, no. 4, 2025, pp. 276–284.

  3. Vannucci, Maria, et al. “Sex-Based Differences in Musculoskeletal Pain among Surgeons: An International Survey.” Surgical Endoscopy, vol. 39, no. 7, 2025, pp. 4217–4224.

  4. Tobias, Gabriel, Shawn X. Dodd, and Joshua N. Wong. “A Survey of Occupational Musculoskeletal Symptoms Among Canadian Plastic Surgeons and Trainees.” Plastic Surgery, vol. 32, no. 4, 2024, pp. 722–727.

  5. Shah, Jinesh, et al. “Ergonomics Among Craniofacial Surgeons: A Survey of Work-Related Musculoskeletal Discomfort and Injury.” Journal of Craniofacial Surgery, vol. 32, no. 7, 2021, pp. 2411–2415.

  6. Scarcella, Joshua, et al. “Understanding the Impact of Ergonomic Practices on Musculoskeletal-Related Symptoms and Emotional Wellness in Craniofacial Surgeons.” Journal of Craniofacial Surgery, vol. 36, no. 2, 2025, pp. 469–472.

  7. White, Alexandra J., Amy S. Nowacki, Sarah I. Woodrow, Michael P. Steinmetz, and Deborah L. Benzil. “Ergonomics, Musculoskeletal Disorders, and Surgeon Gender in Spine Surgery: A Survey of Practicing Spine Surgeons.” Journal of Neurosurgery: Spine, vol. 40, no. 4, 2024, pp. 529–538.

  8. Johnson, Evan P., et al. “Hand Surgeon Posture: An Evaluation and Factors That Affect It.” Journal of Hand and Microsurgery, vol. 16, no. 2, 2024, article 100044.

  9. Zulbaran-Rojas, Alejandro, et al. “Objective Assessment of Postural Ergonomics in Neurosurgery: Integrating Wearable Technology in the Operating Room.” Journal of Neurosurgery: Spine, vol. 41, no. 1, 2024, pp. 135–145.

  10. Arrighi-Allisan, Annie E., et al. “Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope.” Otology & Neurotology, vol. 44, no. 6, 2023, pp. 542–548.

  11. Leung, Karen L., Rachel M. Segal, Jeffrey D. Bernstein, Ryan K. Orosco, and Chris M. Reid. “Surgical Ergonomics: Assessment of Surgeon Posture and Impact of Training Device during Otolaryngology Procedures.” Laryngoscope Investigative Otolaryngology, vol. 7, no. 5, 2022, pp. 1351–1359.

  12. Pankratov, E. L. “On Model for Analysis of Skeletal Muscle Contraction.” Trends in Clinical and Medical Sciences, vol. 4, no. 2, 2025, pp. 1–3.

  13. Lee, Kwang Chear, et al. “Evaluating the Use of a 3D Exoscope to Improve Ergonomics in Cleft Surgery.” The Cleft Palate-Craniofacial Journal, vol. 63, no. 2, 2026, pp. 345–350.

  14. Demiröz, Anıl, et al. “Enhancing Precision or Adding Complexity? The Impact of Surgical Microscope Use in Palatal Cleft Repair: A Prospective Comparative Study.” Journal of Cranio-Maxillofacial Surgery, vol. 54, no. 5, 2026, article 104536.

  15. Fan, Xuelong, Liyun Yang, Nathalie Young, Ilayda Kaner, Magnus Kjellman, and Mikael Forsman. “Ergonomics and Performance of Using Prismatic Loupes in Simulated Surgical Tasks among Surgeons: A Randomized Controlled, Cross-Over Trial.” Frontiers in Public Health, vol. 11, 2024, article 1257365.

  16. Yang, Liyun, Xuelong Fan, Melanie Hensel, Mikael Forsman, and Magnus Kjellman. “Effects of Prismatic Loupes on Surgeons’ Intraoperative Physical Workload and Musculoskeletal Discomfort in Operating Room.” Ergonomics, vol. 69, no. 8, 2026, pp. 1656–1669.

  17. Byorth, Joseph, John Auden, Rahul Varman, and Joshua Demke. “Shedding Light on Rhinoplasty: Optimal Headlight Angle and Cervical Positioning for Illumination of the Surgical Field.” Journal of Craniofacial Surgery, published online 16 Oct. 2025.

  18. Aloqab, Aysha, Walaa Alturkistany, and Hala M. Nassim Ali. “The Relationship between Surgical Loupes Usage, Workplace Ergonomics, and Musculoskeletal Disorders among Saudi Ophthalmologists.” Saudi Journal of Ophthalmology, vol. 39, no. 2, 2025, pp. 166–173.

  19. Lobo, David, Ramon Sancibrian, Angela Mesones, José Ramón Llata, Monica Williams, and Jaime Viera-Artiles. “Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery.” The Laryngoscope, vol. 134, no. 1, 2024, pp. 79–86.

  20. Santos, Mariline, et al. “Ergonomics in Careers Dedicated to Rhinoplasty: Prevalence and Prevention of Work-Related Musculoskeletal Disorders.” Aesthetic Surgery Journal, vol. 46, no. 2, 2026, pp. 174–184.

  21. Brush, Edward J., Jaana Herranen, and Christian Zowada. “Assessing Practical Readiness in a Kitchen-Based Chemistry Induction: Changes in Self-Efficacy, Item-Level Response Patterns, and Student-Perceived Relevance.” Journal of Materials Education (Electronic), vol. 2025, no. 3–6, 2025, pp. 52–63.

Abdur Rehman Akhtar Warriach
PGT Rawalpindi burn and reconstructive surgery department, Holy Family Hospital Rawalpindi
rownyskrillex@gmail.com
Husnain Khan
HOD Rawalpindi Burn and Reconstructive Surgery department, Holy Family Hospital, Rawalpindi, Pakistan
Sundas Shafique
PGT Department of Paediatric Surgery, Holy Family Hospital, Rawalpindi, Pakistan
Javeria Arshad Kiany
PGT Rawalpindi Burn and Reconstructive Surgery Department, Holy Family Hospital, Rawalpindi, Pakistan
Sania Khalid
PGT Rawalpindi Burn and Reconstructive Surgery Department, Holy Family Hospital, Rawalpindi, Pakistan

How to cite:

Abdur Rehman Akhtar Warriach, Husnain Khan, Sundas Shafique, Javeria Arshad Kiany, Sania Khalid. Impact of Ergonomic Interventions in Cleft Palate Surgery: A Cross-Sectional Analytical Study Assessing Surgeon Performance and Perceived Patient Outcomes. Revista Cultura Científica, 2026 Issue 24. pg. 1667-1675.

Publication History

  • Received: 18/08/2026
  • Accepted: 01/10/2026
  • Published: 07/10/2026
Copyright © 2026, Abdur Rehman Akhtar Warriach, Husnain Khan, Sundas Shafique, Javeria Arshad Kiany, Sania Khalid. Published by Revista Cultura Científica. This article is published as open access under the Creative Commons Attribution 4.0 International (CC BY 4.0) license (http://creativecommons.org/licenses/by/4.0/).

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