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Surgical Team Ergonomics During Robotic Versus Conventional Laparoscopic Surgery: A Prospective Observational Study

This prospective observational study demonstrates that robotic surgery significantly reduces musculoskeletal pain, improves posture, and decreases physical fatigue for both primary surgeons and surgical assistants compared to conventional laparoscopy, confirming that its ergonomic benefits extend across the entire surgical team.

Original authors: Remedios Pérez-Salar, Maria Luisa García-García, José Antonio García-López, Víctor Soria-Aledo

Published 2026-07-31

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CC BY 4.0

Original authors: Remedios Pérez-Salar, Maria Luisa García-García, José Antonio García-López, Víctor Soria-Aledo

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the human body as a high-performance vehicle. For decades, surgeons have been driving this vehicle using a very specific, somewhat awkward steering wheel: the laparoscopic approach. In this method, the surgeon stands over the patient, holding long, rigid tools that act like extensions of their arms. To see inside, they must crane their necks and twist their wrists into unnatural angles, often holding these positions for hours while staring at a screen. It's like trying to paint a detailed masterpiece while standing on one leg, holding a long pole, and looking at your reflection in a mirror. Over time, this "driving style" takes a heavy toll on the driver's body, leading to aches, pains, and fatigue.

Recently, a new kind of car arrived in the garage: the robotic surgical system. Instead of standing over the patient, the main surgeon sits at a comfortable console, looking through a 3D viewer and using controls that mimic natural hand movements. It's like switching from that awkward pole-painting to a smooth, ergonomic gaming setup where your hands and eyes are perfectly aligned. But here's the twist: while we know the main driver (the surgeon) gets a better seat, what about the passengers? In a surgery, there are also assistants standing right next to the patient, holding tools and helping out. Do they get a smoother ride in the robotic car, or are they still stuck in the old, bumpy vehicle? This question is the heart of a new study that asks whether the whole team gets a break when the robot takes the wheel.

The Study: Checking the Team's Comfort

Researchers at the University Hospital "Jose María Morales Meseguer" in Murcia decided to investigate this by listening to the stories of the surgical team. They looked at 92 complex surgeries performed between September 2024 and March 2025. These weren't just any operations; they were intricate procedures involving the stomach, esophagus, and colon. The team compared two groups: those using the traditional "awkward pole" method (conventional laparoscopy) and those using the new "gaming console" method (robotic surgery).

After every single surgery, the main surgeon and the assistants filled out a questionnaire. Think of it like a post-drive survey where they rated their pain, fatigue, and comfort on a scale of 1 to 10. They asked about everything from backaches and neck cramps to how tired their eyes felt and how stressed they were about the clock ticking. The researchers then crunched the numbers, making sure to account for how long the surgery lasted and how tricky the procedure was, to see if the type of surgery itself made a difference.

The Findings: A Smoother Ride for Everyone

The results were clear and surprisingly good news for the whole crew. When the team used the robotic system, the main surgeon reported significantly less pain in their back, neck, shoulders, hands, and legs. They also felt more comfortable, had better posture, and were less physically exhausted. It was as if the robot had taken the weight off their shoulders, literally and figuratively.

But the surprise wasn't just for the main driver. The assistants, who still have to stand right next to the patient and hold the tools, also reported feeling much better in the robotic group. They experienced less pain in their shoulders, hands, backs, and necks, and they felt less fatigued. The data suggests that even though the assistants aren't sitting at the fancy console, the way the robot changes the flow of the surgery helps them too. It's like the robot driver is driving so smoothly that the passengers don't have to brace themselves against every bump.

However, the study also noted that not everything changed. Things like headaches, visual fatigue (tired eyes), and general stress levels didn't show a big difference between the two methods. It seems the robot fixes the physical body but doesn't necessarily make the mental pressure of a complex surgery disappear.

What This Means

The study concludes that robotic surgery isn't just a luxury for the main surgeon; it offers a "team-wide" ergonomic benefit. The authors suggest that when we talk about the advantages of these high-tech machines, we shouldn't just look at the patient or the main doctor. We need to look at the whole crew. While the study doesn't prove that robots will cure all back pain forever, it strongly suggests that switching to this technology makes the workday physically easier for everyone involved. It's a reminder that in the operating room, just like in a car, a comfortable driver and a comfortable crew make for a much better journey.

Technical Summary: Surgical Team Ergonomics During Robotic Versus Conventional Laparoscopic Surgery

Problem Statement
Surgical ergonomics is a critical determinant of the sustainability of minimally invasive surgery, yet the ergonomic burden extends beyond the primary surgeon to the entire surgical team. Conventional laparoscopy is associated with high rates of musculoskeletal disorders (MSDs), with prevalence estimates reaching 90%–100% among surgeons due to constrained instrument movement, non-neutral wrist positions, and suboptimal monitor positioning. While robotic surgery was developed to mitigate these limitations by offering improved visualization and natural instrument control, existing literature has predominantly focused on the ergonomics of the console surgeon. The impact of robotic platforms on surgical assistants, who continue to work directly at the operating table, remains poorly understood. Consequently, there is a gap in knowledge regarding whether the ergonomic benefits of robotics extend to the surgical team as a whole or are limited to the console operator.

Methodology
The authors conducted a prospective, observational, cross-sectional study at a secondary-level hospital between September 2024 and March 2025. The study population included primary surgeons and surgical assistants performing complex esophagogastric and colorectal procedures using either the da Vinci robotic surgical platform or conventional laparoscopy.

Data Collection: Following each of the 92 procedures, primary surgeons and assistants completed a structured, 32-item questionnaire. This instrument assessed professional and procedural characteristics, physical workload, musculoskeletal symptoms (pain in back, neck, shoulders, hands, lower limbs), comfort, posture, and cognitive demands (visual fatigue, stress, distractions).
Measurement: Symptomatic and ergonomic variables were quantified using 1–10 Visual Analogue Scales (VAS), where higher scores indicated greater discomfort or fatigue.
Statistical Analysis: The study employed multivariable linear regression models for the primary analysis, adjusting for perceived procedural complexity and operative duration. The surgical approach (robotic vs. laparoscopic) served as the primary exposure variable. Linear mixed-effects models were utilized as sensitivity analyses to account for correlations arising from repeated observations by the same participants. Analyses were performed separately for primary surgeons and a combined group of surgical assistants.

Key Results
The study included 92 procedures, with 73 completed questionnaires from primary surgeons (79.3% response rate) and 146 from surgical assistants.

Primary Surgeons: After adjusting for complexity and duration, robotic surgery was independently associated with significantly lower scores across most physical and postural domains compared to conventional laparoscopy. The most significant reductions were observed in back pain ( $\beta = -3.64$ ), neck pain ( $\beta = -2.79$ ), and postural discomfort ( $\beta = -2.44$ ). Robotic surgery also correlated with reduced shoulder, hand, and lower-limb pain, as well as decreased physical fatigue and distractions. No significant differences were found for headache, visual fatigue, or perceived stress.
Surgical Assistants: Similar trends were observed among assistants. Robotic surgery was independently associated with lower physical fatigue, reduced pain in the shoulders, hands, back, neck, and lower limbs, and improved posture. The strongest associations were found for shoulder pain ( $\beta = -2.45$ ) and postural discomfort ( $\beta = -2.33$ ).
Sensitivity Analysis: Results from the linear mixed-effects models remained consistent with the primary regression analyses, supporting the robustness of the findings regarding the ergonomic benefits of robotics for both surgeons and assistants.
Additional Factors: Regular physical activity was associated with a lower symptomatic burden. Conversely, higher procedural complexity and longer operative durations were generally associated with increased symptom scores across multiple domains.

Significance and Claims
The authors claim that this study provides evidence that the ergonomic benefits of robotic surgery extend beyond the console surgeon to include surgical assistants, thereby supporting a team-based perspective on surgical ergonomics.

Team-Level Impact: The findings suggest that robotic platforms reduce the perceived ergonomic burden for the entire surgical team, not just the primary operator. This challenges the notion that assistants in robotic procedures face the same traditional postural demands as those in laparoscopic surgery.
Sustainability of Practice: By demonstrating reduced musculoskeletal strain, fatigue, and discomfort, the study posits that robotic surgery may contribute to the long-term sustainability of minimally invasive surgery by mitigating factors that lead to professional burnout and MSDs.
Methodological Contribution: The study is presented as one of the first to evaluate ergonomic burden across the entire surgical team using adjusted analyses and sensitivity mixed-effects models, moving beyond single-surgeon assessments.

The authors conclude that while robotic surgery is associated with a lower ergonomic burden, future multicenter studies combining validated questionnaires with objective biomechanical measures are necessary to confirm these findings. They emphasize that ergonomic assessment should be integrated into the evaluation of surgical approaches alongside traditional clinical and technical criteria.

Technical Summary: Surgical Team Ergonomics During Robotic Versus Conventional Laparoscopic Surgery

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