Assessment methods for surgeons' ergonomics in the operating room: a scoping review

Ergonomics is essential for ensuring safe, high-quality surgical care. However, existing studies vary widely in their clinical settings, terminology, and assessment methods. This scoping review aimed to map the terminology and methods used to evaluate surgeons' ergonomics in real-world surgical environments.

We systematically searched MEDLINE, Embase, CENTRAL, IEEE Xplore, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov from inception to July 1, 2025 for studies that assessed physical, cognitive, or organizational ergonomics. Two reviewers independently screened titles and abstracts, assessed full texts, and extracted study characteristics and outcomes. Assessment tools were categorized as self-reported, observational, direct or instrumental, or computer based. The review protocol was registered in PROSPERO (CRD420251088370).

Ninety-nine studies met the inclusion criteria. Minimally invasive surgery predominated: 60 studies involved laparoscopic surgery (including thoracoscopic and other endoscopic minimally invasive approaches), and 36 evaluated robotic surgery. Comparative designs most frequently compared laparoscopic versus robotic surgery (n = 14). Physical, cognitive, and organizational ergonomics were assessed in 64, 49, and 19 studies, respectively, with 31 addressing multiple domains. Considerable variation was observed in terminology and assessment methods. Physical ergonomics was most commonly evaluated using observational or instrumental approaches, whereas cognitive ergonomics primarily relied on self-reported measures. Computer-based assessments, including artificial intelligence-assisted tools, have recently emerged.

This review provides a structured framework for assessing ergonomics in surgery and highlights substantial heterogeneity in terminology and assessment methods. Standardized, multimodal, and objective approaches are needed to enhance comparability across studies.