Evolution of ergonomics in thoracic surgery: a comparative analysis of the surgeon's physical and cognitive load...

Minimizing patient trauma in thoracic surgery introduces hidden ergonomic and cognitive burdens for the surgeon. This review aims to comparatively analyze these loads during the transition from thoracoscopy (video-assisted thoracoscopic surgery - VATS) to robotic-assisted surgery (robotic-assisted thoracic surgery - RATS).

A literature review was conducted focusing on objective (surface electromyography, RULA kinematic analysis, eye blink rate) and subjective (NASA--TLX) ergonomic assessments in multi-port VATS, uniportal VATS (uVATS), and RATS during pulmonary resections.

Conventional VATS is associated with extreme static ischemia of the axial skeleton. Transitioning to uVATS improves the viewing axis, but increases frustration due to instrument clashing. RATS eliminates postural strain (significantly improved RULA scores); however, the lack of haptic feedback and spatial isolation lead to a measurable increase in cognitive load and psychological stress. Newer approaches (uRATS, bi-RATS) represent an effort to compromise between invasiveness and ergonomics. Clinically, RATS is associated with higher postoperative patient pain; however, improved ergonomics and tremor elimination demonstrably correlate with a higher quality of lymphadenectomy and oncological radicality.

Robotic surgery shifts the surgeon's burden from the physical to the cognitive domain. Understanding this paradigm is crucial for preventing musculoskeletal disorders, optimizing training, and ensuring maximum oncological safety for the patient.