Background Robot-assisted surgical systems have been introduced to improve the outcome of minimally invasive surgery. These systems also have the potential to improve ergonomics for the surgeon during endoscopic surgery. This study aimed to compare the user's mental and physical comfort in performing standard laparoscopic and robot-assisted techniques. Surgical performance also was analyzed. Methods In this study, 16 surgically inexperienced participants performed three tasks using both a robotic system and standard laparoscopic instrumentation. Distress was measured using questionnaires and an ambulatory monitoring system. Surgical performance was analyzed with time-action analysis. Results The physiologic parameters (p = 0.000), the questionnaires (p = 0.000), and the time-action analysis (p = 0.001) favored the robot-assisted group in terms of lower stress load and an increase in work efficiency. Conclusion In this experimental setup, the use of a robotassisted surgical system was of value in both cognitive and physical stress reduction. Robotic assistance also demonstrated improvement in performance.

BackgroundLaparoscopic surgery potentially increases the physical burden to operating theater personnel and can cause physical discomfort. This study aims to evaluate if a robotic camera holder (AutoLap™ system) can improve ergonomics for the surgeon and the camera assistant during laparoscopic procedures.MethodsA total of thirty cases were included and randomized (15 AutoLap™, 15 control). Five types of surgery were included: right hemicolectomy, fundoplication, sigmoid resection, rectopexy, and low anterior resection. The posture of the surgeon and assistant was photographed during predefined steps of the procedure. MATLAB was used to calculate angles relevant for the RULA score. The RULA score is a validated method to evaluate body posture, force and repetition of the upper extremities. Two investigators assessed the RULA score independently. Three subjective questionnaires (SMEQ, NASA TLX, and LED) were used to assess mental and physical discomfort.ResultsNo differences in patient characteristics were observed. Sixteen fundoplications, seven right hemicolectomies, five sigmoid resections, one rectopexy, and one low anterior resection were included. The mean RULA score of the surgeon was comparable in both groups, 2.58 (AutoLap™) versus 2.72 (control). The mean RULA score of the assistant was significantly different in both groups, with 2.55 (AutoLap™) versus 3.70 (control) (p = 0.001). The inter-observer variability (ICC) was excellent with 0.93 (surgeon) and 0.97 (assistant). The questionnaires showed a significant difference in physical discomfort for the assistant. The LED and SMEQ score were significantly lower in the robotic group. The NASA TLX demonstrated a significant reduction in scores in all domains when using robotics with the exception of the mental domain.ConclusionUse of the AutoLap™ system shows improvement in ergonomics and posture of the first assistant, and ergonomics of the surgeon are not affected. Furthermore, the subjective work load is significantly reduced by using a robotic camera holder.Trial registration numberNCT0339960, https://clinicaltrials.gov/ct2/show/study/NCT03339960?term=autolap&rank=5.

The use of the da Vinci robot in minimal invasive surgery comes with numerous advantages. Recent papers describe improvements in the ergonomic environment and benefits for the surgeon's posture in the console. Ergonomics for first assistants or scrub nurses at the OR table during robot-assisted procedures, however, have gained minor attention. The aim of this study, therefore, is to analyse the ergonomic environment specifically for first assistants during robot-assisted surgery. Three techniques were used to evaluate body posture and ergonomics during three discriminated actions. First of all, a questionnaire was conducted. Second, sagittal and dorsal photographs of all first assistants were shot. From these photographs, joint angles of the trunk, neck, shoulder, elbow, pelvic girdle and spine were calculated and rapid upper limb assessment (RULA) scores were determined. In addition, intra-observer variability was assessed to determine the robustness of the results. Lastly, the number of obstructions during the surgery was registered by an observer present at the operation theatre. The questionnaires displayed that 73% of the first assistants were in uncomfortable working positions for longer periods of time. Twenty percent of the participants even report pain or visible bruising due to hinderance of the robot arm. Furthermore, an average of 2.8 obstructions per surgical procedure was registered, mainly affecting the lower arm (60%). The photographs demonstrated that all joint angles, except for the elbow joint, are potentially harmful when assisting during robot-assisted surgery. RULA scores revealed high-risk ergonomic risk scores for all measured actions. Tissue traction was recognized as the action with the highest physical workload. During robot-assisted surgery, first assistants experience non-ergonomic trunk, neck and shoulder angles. These recordings are supported by posture analysis. Tissue traction is reported as the most intensive action by the nurses. Tacking, however, can lead to the most unfavourable RULA score. The surgeon's awareness of the position of the robot arms could reduce the number of obstructive moments for the first assistant. Lowering the number of instrument replacements is plausible to lead to better ergonomic postures for first assistant.