Redefining surgical ergonomics: a systematic review of ergonomic outcomes in robotic urological surgery

Urological surgeons have been shown to suffer with significant musculoskeletal (MSK) discomfort during their careers directly attributed to their work. Robot-assisted surgery (RAS) is believed to offer superior ergonomics to traditional forms of surgery but concerns still exist around their use. This systematic review collates the currently available literature on the ergonomic outcomes of RAS in urology and offers comparison to other surgical modalities. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines formed the basis of this review, and the study protocol was registered in PROSPERO (CRD420250650617). A thorough database search was conducted in MEDLINE/PubMed and EMBASE, with twenty-two articles eventually included in the review. Data analysis included a narrative synthesis, and sub-group meta-analysis where data homogeneity allowed. Overall, RAS offers a more ergonomic environment for urological procedures than laparoscopic, open, or endoscopic surgery. Questionnaire-based studies demonstrated favourable use among urological surgeons, although numerous issues persist such as neck and back pain. Postural and muscular assessments similarly showed improvements in ergonomy for RAS. However, prolonged poor ergonomic joint positions, and moderate activation of upper body muscles were noted in all forms of surgery. Task load indexes demonstrated lower physical demand among RAS. While RAS offers a superior ergonomic environment to minimally invasive and open surgical techniques in urology, numerous challenges still exist. Continued study is needed, and formal ergonomic assessments should become standard protocol for any emerging robotic systems to ensure that proper ergonomy is maintained across a diverse surgical population.