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Ergonomic strain of robotic-assisted versus laparoscopic inguinal hernia repair (ESRALI)-a crossover trial
Alexandros Valorenzos1,2,3, Kristian Als Nielsen4,5,6, Per Helligsø4
1Department of General Surgery, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. alexandros.valsamidis.valorenzos@rsyd.dk.
Background:
Robotic-assisted and laparoscopic techniques are widely used for inguinal hernia repair. While robotic-assisted transabdominal preperitoneal (rTAPP) repair is believed to offer ergonomic advantages for surgeons, there is limited evidence comparing its ergonomic impact to conventional laparoscopic TAPP (cTAPP) repair. This study aims to assess the ergonomic strain on surgeons during these procedures using subjective and objective measures.
Methods:
This crossover observational study involved four experienced hernia surgeons who performed two procedures using each technique. Ergonomic strain was evaluated through self-reported perceived exertion (using the Borg scale), surface electromyography (sEMG) of select muscle groups, and posture analysis using rapid upper limb assessment (RULA) scores derived from kinematic data collected via Xsens Awinda. Statistical comparisons were conducted using the Wilcoxon rank-sum test, with adjustments for multiple comparisons.
Results:
Subjectively, surgeons perceived rTAPP as less physically demanding, with lower postoperative perceived exertion scores (median 1.5 vs. 3.0, p < 0.01). Objective measurements showed higher static muscle activity in the left erector spinae and median activity in the right trapezius during rTAPP (p = 0.016), but overall ergonomic strain, as indicated by RULA scores, was similar across modalities. Median RULA scores for both techniques were 3, and no significant differences were observed in work posture scores. Despite these findings, discomfort during cTAPP was more frequently reported, with surgeons citing the neck, shoulders, and lower back as affected areas.
Conclusion:
While rTAPP was subjectively perceived as less physically demanding, objective metrics did not corroborate these perceptions, showing comparable ergonomic strain between techniques. These findings highlight a complex relationship between subjective and objective ergonomic measures and suggest a need for further research, incorporating broader assessments of cognitive and physical loads, to optimize surgeon ergonomics in minimally invasive procedures.
