The Jefferson Operative Room Setup for Endoscopic Skull Base Surgery

Introduction: As dedicated endoscopy suites for skull base surgery are becoming more prevalent, it is important to consider the optimal operative room setup. Multiple techniques have been presented for surgeon positioning for two-team endoscopic skull base surgery. Classically, the neurosurgeon and otolaryngologist stand adjacent to each other on the same side of the patient bed while operating. We describe an alternative approach utilizing dynamic endoscopy where the two surgeons stand across from each other. We discuss the merits of this approach from both a neurosurgical and otolaryngological perspective. Methods and results: We describe our technique of surgeon positioning, monitor positioning, operating room setup, and their implications on ergonomics and surgeon fatigability. Conclusion: We believe our approach of surgeon positioning, where surgeons stand on opposite sides of the patient bed while operating, to be a viable and more ergonomic alternative to the classical approach.