Visual and Musculoskeletal Demands of Microsurgery—Delving into the Ergonomics and Suggesting Corrective Strategies

Abstract In microsurgery, we often focus on the flap survival but less often on the surgeon's survival. Microsurgery, although rewarding, presents many visual and musculoskeletal challenges and demands for surgeons. Prolonged magnification, reduced blink rate, altered pupillary responses, and compromised stereopsis contribute to ocular fatigue, while sustained non-neutral postures and cervical strain increase the risk of musculoskeletal disorders. This narrative review was conducted through a comprehensive search of the PubMed, Google Scholar, and Cochrane Library databases. Articles published between 1982 and 2025 were evaluated to provide a longitudinal perspective on microsurgical performance. This article shows the physiological challenges faced by microsurgeons, including ocular surface stress, cognitive workload, and cervical biomechanics. Preventive strategies such as ergonomic optimization, microbreaks, strength training, ocular exercises, and yoga-based practices are highlighted as practical measures to enhance surgeon's well-being and performance. Microsurgeons face various challenges during microsurgery, and it is essential to adopt preventive strategies to minimize fatigue, reduce occupational health risks, and maintain surgical precision throughout their careers to enhance and prolong them.