Improving ergonomics in the OR involves looking at both the surgeon and their work environment. While certain aspects of both these facets cannot be changed (e.g. surgeon height, patient anatomy) others are within the scope of the individual surgeon.
Be aware of your posture in the OR and take measures to optimize it. Ensure that the table height is suitable for you and your assistant (especially trainees, as they are unlikely to state that they are experiencing discomfort) even if it means that you’re standing on steps. Avoid motions that twist the spine, rather change the position of your hips so that the spine stays aligned. Use the larger upper back muscles (latissimus dorsi) rather than the trapezius to retract.
When loupes are needed, use them for short periods of time and only during the portions of the case where absolutely necessary. Ensure to invest in lightweight models with larger declination angles so that the neck doesn’t need to be flexed as far forward. It is important to have loupes fitted to the user. Look for alternative ways to get the visualization you need. For example, a neurosurgeon colleague (and he knows spines!) told me that he had abandoned his loupes early in his career as an attending and switched to the operating microscope for ergonomic reasons. The same principles apply to headlights and lead aprons in that they should be used for only the critical portions of cases. I’ve found lighted retractors to be helpful replacements for headlights, at least for some cases.
Taking breaks is one of the most effective strategies employed in industrial ergonomics to reduce discomfort and improve performance. Both microbreaks and targeted exercises have also been shown to improve pain and physical performance while operating, without adversely affecting (and sometimes improving) mental focus. Our anesthesiology and nursing colleagues certainly realized the importance of breaks and adopted them a long time ago. Why haven’t we?