Effect of a physical training program on simulated laparoscopic performance in gynecologic surgery: a randomized controlled trial

Gynecologic laparoscopy exposes surgeons to considerable physical constraints that may lead to musculoskeletal disorders, impaired posture and reduced performance. Targeted physical training has been proposed as a preventive strategy, but its effect on surgical performance is unclear. This randomized controlled trial involved 26 obstetrics and gynecology residents who were allocated either to a training group (n = 13) or a control group (n = 13). The training group completed a 6-week semi-supervised physical training program combining resistance and mobility exercises. Assessments were performed before (pre) and after (post) the training period and included: (i) muscle strength using the five-repetition maximum [5RM] tests on key muscle groups involved in gynecologic laparoscopy, (ii) a standardized laparoscopic suturing task (SUTT), (iii) surface electromyography (EMG), (iv) postural control analysis using a force platform, and (v) perceived workload using the SURG-TLX questionnaire. The training group showed significant strength gains compared with the control group in three of the five 5RM tests (seated row, right lateral raise, and lumbar extension; all p < 0.05), whereas differences for the face pull and left lateral raise did not reach significance. However, no significant between-group differences were observed in SUTT performance scores or completion times, either before or after the simulated workday. Similarly, no training effect was detected in postural stability or EMG activity. The occupational protocol increased postural sway in both groups, but training did not influence this increase. SURG-TLX scores did not differ between groups, with mental demand, physical demand, and task complexity being rated the highest. A short, tailored physical training program significantly improved muscle strength, yet it did not enhance simulated laparoscopic performance or modify neuromuscular or postural responses. The identification of marked postural asymmetries, which are characteristic of gynecologic laparoscopy, may help explain musculoskeletal complaints and support the need for ergonomic and training interventions in future studies.