Skip to main content
SpringerLink
Log in

A comparison of laparoscopic and robotic ergonomic risk

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Work related injuries in minimally invasive surgery (MIS) are common because of the strains placed on the surgeon’s or assistant’s body. The objective of this study was to compare specific ergonomic risks among surgeons and surgical trainees performing robotic and laparoscopic procedures.

Materials and methods

Ergonomic data and discomfort questionnaires were recorded from surgeons and trainees (fellows/residents) for both robotic and laparoscopic procedures. Perceived discomfort questionnaires were recorded pre/postoperatively. Intraoperatively, biomechanical loads were captured using motion tracking sensors and electromyography (EMG) sensors. Perceived discomfort, body position and muscle activity were compared between robotic and laparoscopic procedures using a linear regression model.

Results

Twenty surgeons and surgical trainees performed 29 robotic and 48 laparoscopic procedures. Postoperatively, increases in right finger numbness and right shoulder stiffness and surgeon irritability were noted after laparoscopy and increased back stiffness after robotic surgery. Further, the laparoscopic group saw increases in right hand/shoulder pain (OR 0.8; p = 0.032) and left hand/shoulder pain (0.22; p < 0.001) compared to robotic. Right deltoid and trapezius excessive muscle activity were significantly higher in laparoscopic operations compared to robotic. Demanding and static positioning was similar between the two groups except there was significantly more static neck position required for robotic operations.

Conclusion

Robotic assisted surgeries led to lower postoperative discomfort and muscle strain in both upper extremities, particularly dominant side of the surgeon, but increased static neck positioning with subjective back stiffness compared with laparoscopy. These recognized ergonomic differences between the two platforms can be used to raise surgeon awareness of their intraoperative posture and to develop targeted physical and occupational therapy interventions to decrease surgeon WMSDs and increase surgeon longevity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cuschieri A (1992) The spectrum of laparoscopic surgery. World J Surg 16:1089–1097

    Article  CAS  PubMed  Google Scholar 

  2. Fitch K, Engel T, Bochner A (2015) Cost differences between open and minimally invasive surgery. Manag Care 24:40–48

    PubMed  Google Scholar 

  3. Berguer R, Forkey D, Smith W (1999) Ergonomic problems associated with laparoscopic surgery. Surg Endosc 13:466–468

    Article  CAS  PubMed  Google Scholar 

  4. Esposito C, El Ghoneimi A, Yamataka A, Rothenberg S, Bailez M, Ferro M, Gamba P, Castagnetti M, Mattioli G, Delagausie P (2013) Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey. J Pediatr Surg 48:1750–1756

    Article  PubMed  Google Scholar 

  5. Franasiak J, Ko EM, Kidd J, Secord AA, Bell M, Boggess JF, Gehrig PA (2012) Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery. Gynecol Oncol 126:437–442

    Article  PubMed  Google Scholar 

  6. Gofrit ON, Mikahail AA, Zorn KC, Zagaja GP, Steinberg GD, Shalhav AL (2008) Surgeons’ perceptions and injuries during and after urologic laparoscopic surgery. Urology 71:404–407

    Article  PubMed  Google Scholar 

  7. Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D (2010) Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg 210:306–313

    Article  PubMed  Google Scholar 

  8. Sari V, Nieboer TE, Vierhout ME, Stegeman DF, Kluivers KB (2010) The operation room as a hostile environment for surgeons: physical complaints during and after laparoscopy. Minim Invasive Ther Allied Technol 19:105–109

    Article  PubMed  Google Scholar 

  9. Wauben L, Van Veelen M, Gossot D, Goossens R (2006) Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc 20:1268–1274

    Article  CAS  PubMed  Google Scholar 

  10. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239:14

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tan A, Ashrafian H, Scott AJ, Mason SE, Harling L, Athanasiou T, Darzi A (2016) Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Surg Endosc 30:4330–4352

    Article  PubMed  PubMed Central  Google Scholar 

  12. Catanzarite T, Tan-Kim J, Whitcomb EL, Menefee S (2018) Ergonomics in surgery: a review. Female Pelvic Med Reconstr Surg 24:1–12

    Article  PubMed  Google Scholar 

  13. Franasiak J, Craven R, Mosaly P, Gehrig PA (2014) Feasibility and acceptance of a robotic surgery ergonomic training program. J Soc Laparoendoscopic Surg 18:e2014.00166

    Article  Google Scholar 

  14. Lee J, Kang SW, Jung JJ, Choi UJ, Yun JH, Nam KH, Soh E-Y, Chung WY (2011) Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations. Ann Surg Oncol 18:2538–2547

    Article  PubMed  Google Scholar 

  15. Plerhoples TA, Hernandez-Boussard T, Wren SM (2012) The aching surgeon: a survey of physical discomfort and symptoms following open, laparoscopic, and robotic surgery. J Robot Surg 6:65–72

    Article  PubMed  Google Scholar 

  16. Santos-Carreras L, Hagen M, Gassert R, Bleuler H (2012) Survey on surgical instrument handle design: ergonomics and acceptance. Surgical innovation 19:50–59

    Article  PubMed  Google Scholar 

  17. Yu D, Dural C, Morrow MM, Yang L, Collins JW, Hallbeck S, Kjellman M, Forsman M (2017) Intraoperative workload in robotic surgery assessed by wearable motion tracking sensors and questionnaires. Surg Endosc 31:877–886

    Article  PubMed  Google Scholar 

  18. Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR (2014) Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 28:456–465

    Article  PubMed  Google Scholar 

  19. Marecik SJ, Chaudhry V, Jan A, Pearl RK, Park JJ, Prasad LM (2007) A comparison of robotic, laparoscopic, and hand-sewn intestinal sutured anastomoses performed by residents. Am J Surg 193:349–355

    Article  PubMed  Google Scholar 

  20. Stefanidis D, Wang F, Korndorffer JR, Dunne JB, Scott DJ (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24:377–382

    Article  PubMed  Google Scholar 

  21. Berguer R, Smith W (2006) An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity. J Surg Res 134:87–92

    Article  PubMed  Google Scholar 

  22. Athanasiadis DI, Monfared S, Asadi H, Colgate CL, Yu D, Stefanidis D (2021) An analysis of the ergonomic risk of surgical trainees and experienced surgeons during laparoscopic procedures. Surgery 169:496–501

    Article  PubMed  Google Scholar 

  23. Beurskens AJ, Bültmann U, Kant I, Vercoulen JH, Bleijenberg G, Swaen GM (2000) Fatigue among working people: validity of a questionnaire measure. Occup Environ Med 57:353–357

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Asadi H, Monfared S, Athanasiadis DI, Stefanidis D, Yu D (2021) Continuous, integrated sensors for predicting fatigue during non-repetitive work: demonstration of technique in the operating room. Ergonomics 64(9):1160–1173

    Article  PubMed  Google Scholar 

  25. Garg A, Kapellusch J, Hegmann K, Wertsch J, Merryweather A, Deckow-Schaefer G, Malloy E, Team WHSR (2012) The strain index (SI) and threshold limit value (TLV) for hand activity level (HAL): risk of carpal tunnelsyndrome (CTS) in a prospective cohort. Ergonomics 55:396–414

    Article  CAS  PubMed  Google Scholar 

  26. McAtamney L, Corlett EN (1993) RULA: a survey method for the investigation of work-related upper limb disorders. Appl Ergon 24:91–99

    Article  CAS  PubMed  Google Scholar 

  27. Szeto GPY, Cheng SWK, Poon JTC, Ting ACW, Tsang RCC, Ho P (2012) Surgeons’ static posture and movement repetitions in open and laparoscopic surgery. J Surg Res 172:e19–e31

    Article  PubMed  Google Scholar 

  28. Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung J (1997) A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc 11:139–142

    Article  CAS  PubMed  Google Scholar 

  29. Uhrich M, Underwood R, Standeven J, Soper N, Engsberg J (2002) Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery. Surg Endosc 16:635–639

    Article  CAS  PubMed  Google Scholar 

  30. Lee E, Rafiq A, Merrell R, Ackerman R, Dennerlein J (2005) Ergonomics and human factors in endoscopic surgery: a comparison of manual vs telerobotic simulation systems. Surg Endosc Other Interv Tech 19:1064–1070

    Article  CAS  Google Scholar 

  31. Steven Moore J, Garg A (1995) The strain index: a proposed method to analyze jobs for risk of distal upper extremity disorders. Am Ind Hyg Assoc J 56:443–458

    Article  Google Scholar 

  32. Lawson EH, Curet MJ, Sanchez BR, Schuster R, Berguer R (2007) Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project. J Robot Surg 1:61–67

    Article  PubMed  PubMed Central  Google Scholar 

  33. Armijo PR, Huang C-K, High R, Leon M, Siu K-C, Oleynikov D (2019) Ergonomics of minimally invasive surgery: an analysis of muscle effort and fatigue in the operating room between laparoscopic and robotic surgery. Surg Endosc 33:2323–2331

    Article  PubMed  Google Scholar 

  34. Zihni AM, Ohu I, Cavallo JA, Cho S, Awad MM (2014) Ergonomic analysis of robot-assisted and traditional laparoscopic procedures. Surg Endosc 28:3379–3384

    Article  PubMed  Google Scholar 

  35. Milone M, Manigrasso M, Vertaldi S, Velotti N, Aprea G, Maione F, Gennarelli N, De Simone G, De Conno B, Pesce M (2019) Robotic versus laparoscopic approach to treat symptomatic achalasia: systematic review with meta-analysis. Dis Esophagus 32:1–8

    Article  CAS  PubMed  Google Scholar 

  36. Olavarria OA, Bernardi K, Shah SK, Wilson TD, Wei S, Pedroza C, Avritscher EB, Loor MM, Ko TC, Kao LS (2020) Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ 370:m2457

    Article  PubMed  PubMed Central  Google Scholar 

  37. Yu H-y, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Hu JC (2012) Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery. J Urol 187:1392–1399

    Article  PubMed  Google Scholar 

  38. Sheldon GF (2010) Access to care and the surgeon shortage: American Surgical Association Forum. Ann Surg 252:582–590

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Sara Monfared, Dimitrios I. Athanasiadis, Luke Umana, Edward Hernandez, Cameron L. Colgate & Dimitrios Stefanidis

  2. Purdue University, West Lafayette, IN, USA

    Hamed Asadi & Denny Yu

Authors
  1. Sara Monfared
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitrios I. Athanasiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luke Umana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edward Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hamed Asadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cameron L. Colgate
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Denny Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dimitrios Stefanidis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dimitrios Stefanidis.

Ethics declarations

Disclosures

This submission was funded by SAGES. Dr. Monfared, Dr. Umana, Mr. Asadi, and Mr. Colgate have no conflicts of interest or financial ties to disclose. Dr. Athanasiadis has an unrelated CTSI grant. Dr. Hernandez has an unrelated SAGES research grant for a different project and an unrelated CTSI grant. Dr. Yu has an unrelated grant from Intuitive Surgical, Inc. Dr. Stefanidis has unrelated research grants from ExplORer Surgical, Inc, and from Bard.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Monfared, S., Athanasiadis, D.I., Umana, L. et al. A comparison of laparoscopic and robotic ergonomic risk. Surg Endosc 36, 8397–8402 (2022). https://doi.org/10.1007/s00464-022-09105-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09105-0

Keywords

Search

Navigation