Robotic assisted surgery reduces ergonomic risk during minimally invasive inguinal hernia repair: the VOLTAIRE...

This is the first randomised controlled trial to assess the operating ergonomics of open console robotic surgery for inguinal hernia surgery. Intraoperative ergonomic risk was assessed using the Rapid Entire Body Assessment (REBA) scale, with photographs taken at 1-min intervals. Secondary outcomes included team nontechnical skills (NTS) assessment, surgeon cognitive strain, and patient clinical outcomes. Patients were stratified on unilateral/bilateral hernias. Sixty patients were randomised, 1 was withdrawn (39 robot:20 lap). Robotic REBA scores were significantly lower than laparoscopic (median robot 3.0 vs lap 5.0 [p ​< ​0.001]). Robotic operations were longer (mean 64.9 ​± ​21.1 ​min vs 31.7 ​± ​10.3 ​min [p ​< ​0.001]). More robotic patients had resumed normal activities at 14-days (15(39 ​%) vs 1(5 ​%) [p ​= ​0.006]). Team NTS (Oxford NOTECHS II) and surgeon cognitive strain (modified NASA-TLX) were unaffected by modality, and all other patient outcomes were equal. This trial demonstrates that robotic surgery reduces ergonomic risk during inguinal hernia surgery, with no detriment to cognitive strain or team functioning. This may therefore be a safe & feasible solution to the increasing problem of work-related musculoskeletal injuries in surgeons.