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Robotic-Assisted Surgery
Robotic-assisted surgery is widely considered to be more ergonomic than laparo-
scopic; however, challenges remain [ 8 , 81 , 82 ]. Approximately half of surgeons
experience physical discomfort due to robotic surgery [ 8 , 19 , 20 ]. Symptoms include
neck stiffness, as well as finger and eye fatigue [ 27 , 83 ]. Eye fatigue improved with
the introduction of enhanced high-definition visualization with the da Vinci Si™
[ 83 ]. The robotic console will adjust to appropriate heights for surgeons between 64
and 73 inches. However, surgeons shorter than 64 inches will need to extend their
necks or raise the height of the chair to use the eyepiece. Raising the chair makes it
more difficult to reach the pedals without applying extensive pressure on the popli-
teal area or requiring foot rests that interfere with pedal operation. Surgeons taller
than 73 inches will assume a flexed neck position while using the eyepieces [ 84 ].
Professions utilizing similar seated positions, such as microscopists, have an
increased risk of chronic kyphosis due to years spent bending over the scope [ 85 ].
As robotic surgery becomes more prevalent, ergonomic shortfalls and the accompa-
nying physical repercussions for robotic surgeons may manifest in the future.
Gender and Anthropometry
Studies suggest female surgeons have greater than a twofold risk for physical
discomfort associated with laparoscopy when compared to their male counter-
parts [ 9 , 26 ]. This may be because women are more likely to have small hand size
and short stature [ 86 , 87 ]. Surgeons with a glove size less than 6.5 report more
difficulty with using laparoscopic instruments than those with a larger glove size
[ 88 ]. Female surgeons are more likely to describe laparoscopic instruments as too
big and are over three times more likely than men to receive treatment for hand
injuries [ 89 ]. A more ergonomic design for laparoscopic instruments should con-
sider varying hand sizes and strengths. Women are also more likely than men to
experience shoulder and neck pain [ 90 ]. Short stature has been correlated with
shoulder and neck pain during laparoscopy due to excessive shoulder abduction to
accommodate for the length of the instruments [ 89 , 91 ]. In general, females are
more likely to seek medical treatment for their injuries [ 92 ]. Therefore, higher
rates of physical discomfort and injury could also be due to increased reporting.
Surgical Inexperience
Surgery residents may also have unique risk factors for occupational injury. Hemal
and colleagues reported that those with less than 2 years of experience have signifi-
cantly higher rate of finger numbness and eye strain than their more senior col-
leagues, despite having an equivalent laparoscopic workload. The researchers
hypothesize that inexperience or anxiety may contribute to ergonomic errors such as
higher grip force of instruments or incorrect body posture [ 16 , 46 ]. This is consistent
with a study by Uhrich et al., which showed that residents experienced significantly
greater discomfort than attending surgeons as well as increased muscle load of sev-
eral muscle groups while performing the same tasks as staff surgeons [ 7 , 46 , 72 ]. In
other professions, workers with less experience have higher prevalence of musculo-
skeletal problems due to poorer job skills and insufficient practice [ 93 , 94 ].
C. Ronstrom et al.