A systematic review of ergonomic and muscular strain in surgeons comparing robotic to laparoscopic approaches

Robotic-assisted laparoscopic surgery has become more common in recent years with multiple benefits to patients. However, it poses musculoskeletal risks to surgeons, and given their long careers, it is vital to prolong surgeons' longevity. This review aims to evaluate ergonomic impact and methods of ergonomic assessment in surgeons performing traditional and robotic-assisted laparoscopic surgery. To evaluate the ergonomics and how different body areas were being affected by robotic and laparoscopic surgeons, we performed a systematic review of studies following PRISMA guidelines and focussing on muscular and ergonomic assessment of laparoscopic surgeons. Electronic Ovid Medline and Embase databases were searched on the 15th of June 2023. 16 studies were identified, involving 508 surgeons. 530 traditional laparoscopies and 535 robotic-assisted laparoscopies were included. Mixed methods, including surface electromyography (sEMG) and Borg CR10 physical exertion scale, were used to assess muscular activation and fatigue. Whilst individual studies produced conflicting results, overall sEMG and BORG CR10 scales showed that in TLS the deltoid, triceps, biceps and wrist muscles are most commonly activated. In addition, in RALs, lower back, trapezius and finger muscles were activated most commonly. Muscle activations as a whole were generally lower in robotic-assisted laparoscopy. Survey tools such as NASA-TLX confirmed that overall RALS was less fatiguing than TLS for the majority of surgeons. This review explored the ergonomic risks faced by surgeons performing both traditional laparoscopic and robotic surgery. Further research, including standardised methodology and continuous ergonomic assessment, are warranted to ensure robotic surgery remains safe.