Evidence-based ergonomic parameters for safer surgical practice: a systematic review

Work-related musculoskeletal disorders are highly prevalent among surgeons and are primarily associated with sustained non-neutral postures, inadequate visualization, improper table height, and insufficient adaptation to individual anthropometry; therefore, this systematic review aimed to synthesize evidence on ergonomic risk factors and define evidence-based parameters for safer surgical practice.

A comprehensive systematic search of multiple databases was conducted using predefined eligibility criteria, including studies evaluating surgeon anthropometry, visualization techniques, table height, muscle activity, posture, and ergonomic accessories; findings were qualitatively synthesized across predetermined ergonomic domains such as neutral posture, electromyographic fatigue, spinal kinematics, and ergonomic modifications.

Twenty-six studies across laparoscopic, endoscopic, microscopic, otolaryngologic, neurosurgical, and urological procedures were included. Beneficial ergonomic ranges included cervical flexion of 0-10°, shoulder abduction below 30°, trunk inclination under 20°, and minimal neck rotation. Ergonomic redesign reduced trapezius fatigue from 100 to 42%, while monitor-based endoscopy decreased trapezius activity to approximately one-third compared with direct eyepiece viewing. Optimal table height varied widely, commonly defined relative to elbow height or surgeon stature, with required ranges (29-122 cm) exceeding standard table capabilities.

Surgeon ergonomics is strongly influenced by operating room design, visualization setup, and anthropometric variability, and current equipment frequently fails to meet evidence-based requirements, supporting the need for redesigned surgical tables, improved visualization systems, and integrated ergonomic accessories to reduce strain and enhance long-term occupational sustainability.