Surgical team ergonomics during robotic versus conventional laparoscopic surgery: a prospective observational study

Robotic surgery has been associated with improved ergonomics compared with conventional laparoscopy. However, most studies have focused on the console surgeon, and its impact on other members of the operative team remains poorly understood. We conducted an exploratory prospective observational study with repeated procedure-level assessments including robotic and conventional laparoscopic upper gastrointestinal and colorectal procedures performed from September 2024 to March 2025. After each operation, primary surgeons and surgical assistants completed a structured questionnaire assessing perceived musculoskeletal symptoms, posture, discomfort, fatigue, and cognitive workload using numerical rating scales. Linear mixed-effects models were fitted for each ergonomic domain, adjusting for procedure type and accounting for repeated assessments through random effects. Fully adjusted sensitivity analyses additionally included operative duration and perceived procedural complexity. Ninety-two procedures were included. Questionnaires were completed by primary surgeons after 79 procedures (85.9%) and by surgical assistants in 155 assessments (85.2%). Among primary surgeons, robotic surgery was associated with lower adjusted scores across most physical and postural domains, with adjusted mean differences ranging from - 1.52 for lower-limb pain to - 4.27 for back pain. Comparable associations were observed among assistants, particularly for shoulder pain, postural discomfort, and physical fatigue. The direction of the associations remained consistent in the fully adjusted sensitivity analyses. Robotic surgery was associated with lower perceived ergonomic symptom scores than conventional laparoscopy across different members of the surgical team. These findings support evaluating surgical ergonomics from a team-based perspective rather than focusing exclusively on the primary surgeon.