Surgeon posture evaluation during simulated laparoscopic and robotic-assisted cholecystectomy

PURPOSE: Robotic camera systems have been developed to assist surgeons by holding the endoscope during laparoscopic cholecystectomies, a task traditionally performed by a human assistant. While such systems relieve the assistant from an ergonomically unfavorable task, there are concerns about the effects their usage has on the surgeon's posture. Addressing these concerns requires the use of posture assessment methods that are compatible with the constraints of surgical settings. METHODS: This feasibility study compares two simulated cholecystectomies from one surgeon: one performed with robotic endoscope assistance and one without. A scaled medical mockup designed for laparoscopic procedures and a certified robotic endoscope holder (Soloassist 2, AKTORmed GmbH) were applied in an experimental operating room. Two motion capture systems (VICON and Xsens MVN Awinda) were used to capture motion and posture data of the surgeon. RESULTS: The analysis suggests that the surgeon maintains a similar, largely static posture in both scenarios. Despite minor anomalies, the observed postures are predominantly ergonomically correct. Consequently, under the examined conditions, the use of robotic assistance does not support the hypothesis of either conferring ergonomic advantages or disadvantages for surgeons. CONCLUSION: While posture evaluations have traditionally relied on eyewitness observation or questionnaires, this article proposes an exploratory analysis based on acquired motion data. While evidence from a single surgeon is not sufficient to draw generalizable conclusions, the presented approach demonstrates how motion data can be used to objectively assess surgeon posture during laparoscopic and robotic-assisted surgery.