Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project

We hypothesized that a laparoscopic technique for Roux-en-Y gastric bypass surgery is associated with more musculoskeletal discomfort and ergonomic strain than a robotic technique. This pilot project studied one surgeon while he performed four laparoscopic and four robotic (da Vinci system) Roux-en-Y gastric bypass procedures. We measured musculoskeletal discomfort with body part discomfort score (BPD) and ergonomic positioning with the rapid upper-limb assessment tool (RULA). At the end of the case, the robotic cases were associated with more discomfort in the neck (median BPD scores 2.5 versus 1.0, P = 0.028), while the laparoscopic cases were associated with more discomfort in the upper back (median BPD scores 2.0 versus 1.0, P = 0.028). Both the right and left shoulders demonstrated more discomfort with the laparoscopic group (median BPD scores 3.0 versus 1.5, P = 0.057). The RULA analysis demonstrated that the upper arm (1.0 versus 2.25), lower arm (1.125 versus 2.125), wrist (2.5 versus 3.5) and wrist twist (1.25 versus 2) were held in less ergonomically correct positioning (higher score) in the laparoscopic group compared to the robotic group (P = 0.029). In contrast, the trunk (1.5 versus 1.0) had a worse RULA score in the robotic group compared to the laparoscopic cases. These pilot data suggest that robotic Roux-en-Y gastric bypass surgery may result in less musculoskeletal stress to the upper extremities than standard laparoscopic technique. In contrast, robotic surgery seems to offer both postural advantages and disadvantages for the neck and back region. More-detailed studies are needed to fully assess the potential postural advantages of robotic surgical techniques over standard laparoscopy.