Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries



Laparoscopic surgery (LS) may lead to musculoskeletal disorders (MSDs) and an increase in physical and mental workloads to the surgeon. Robot-assisted surgery (RAS) should improve the ergonomy of the surgeon. This study assesses the experience influence in surgical ergonomics between LS and RAS.


LS and RAS lasting more than 60 min of effective operative time were compared. During the surgical procedure, the physical discomfort was evaluated using the Borg scale. At the end, the mental workload was evaluated using the NASA-TLX index. After global analysis, the experienced and young surgeons were assessed.


88 RAS and 82 LS were evaluated. During LS, the physical discomfort was significantly higher in all segments, and the pain increased significantly during the procedure in all segments compared to that evaluated in the RAS (p < 0.05). Forearms and the back were the most painful. The young surgeons did not display any improvement in the physical ergonomics of the RAS compared to the LS. Concerning the mental ergonomics, the overall workload and performance were significantly greater during the LS compared to the RAS (p < 0.05). For the young surgeons, the overall workload, the effort, the mental and the physical demands were greater during LS (p < 0.05). For the experienced surgeons, the physical demand was lower during the RAS compared to the LS (p < 0.05). However, the experienced surgeons expressed a feeling of greater performance after the LS (p < 0.01). RAS significantly reduces the onset of MSDs compared to LS, especially for the experienced surgeons.


RAS significantly reduces the onset of MSDs compared to LS, especially for the experienced surgeons.

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The authors thank Dr. M. Derieppe (Department of Radiology, Leiden UMC, Leiden, the Netherlands) for proofreading the manuscript, and the colleagues of the Department of Urology, the Department of Paediatric Surgery and the Department of Gynaecology of CHU Tours for their fruitful contributions.


This study was realized without any funding, only with surgeon personal investment.

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Correspondence to V. Mendes.

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Conflict of interest

Dr. Hebert reports personal fees from Nordic Pharma, personal fees from Intuitive Surgical, during the conduct of the study; personal fees from Nordic Pharma, personal fees from Intuitive Surgical, outside the submitted work. Drs. Mendes, Bruyere, Escoffre, Binet, Lardy, Marchal and Marret have no conflicts of interest or financial ties to disclose.

Ethical approval

This study assessed only the ergonomy of the surgeon, so hospital institutional review board indicate no patient approvals are required. This article does not contain any studies with animals performed by any of the authors.

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Mendes, V., Bruyere, F., Escoffre, J.M. et al. Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries. J Robotic Surg 14, 115–121 (2020). https://doi.org/10.1007/s11701-019-00933-2

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  • Ergonomics
  • Robot-assisted surgery
  • Laparoscopic surgery
  • Borg scale
  • NASA-TLX index