Musculoskeletal pain among surgeons performing minimally invasive surgery: a systematic review

Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons. In this review, we aimed to systematically evaluate the existing literature comparing the two surgical modalities.

A systematic literature search was employed in PubMed, Embase and Cochrane Library in spring 2015. Inclusion criteria were as follows: English language, full text available, original data, and comparative data on surgeons' physical workload with robotic-assisted laparoscopy and conventional laparoscopy. Studies only describing a single surgical modality were excluded. We applied the checklist, STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), to assess the quality of reporting of the included studies. Semi-quantitative comparisons were made.

In total, 2685 records were screened and 15 articles were included in the analysis. All studies were observational with sample sizes ranging from one single surgeon to 250 questionnaire responses. None of the studies fully fulfilled the criteria of STROBE, with an average score of 13 (range 10-16) out of 18.

Results, mainly self-reported measures, suggest that robotic-assisted laparoscopy is less strenuous compared with conventional laparoscopy. However, results are limited by the large methodological heterogeneity and a high risk of bias. We advocate for further high-quality exposure studies to assess the potential ergonomic deficits related to different minimally invasive surgical techniques. In addition, future intervention studies should evaluate possible means to alleviate and prevent musculoskeletal pain among surgeons.