Objective assessment of surgeon’s ergonomics and posture in robotic-assisted (RATS) versus video-assisted thoracoscopic (VATS) lobectomy during vascular structures isolation

Abstract Background Suboptimal ergonomic postures during surgical procedures increase the susceptibility to work-related musculoskeletal disorders. We objectively compared surgeons’ ergonomics and posture between robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) lobectomy, using the validated rapid upper limb assessment (RULA) score. Methods A prospective observational study evaluated 59 lobectomies performed by seven surgeons. Surgeon’s joint angles were tracked during real-life procedures using two software applications (Kinovea-0.9.5 and APECS platform). Sagittal and dorsal videos were recorded during robot ( n = 31) and multiportal thoracoscopic ( n = 28) lobectomies. We calculated neck, shoulder, elbow, trunk, hip, knee, and specific tilt angles to estimate the RULA scores for ergonomic risk during dissection/division of vascular structures. Data were analysed using linear mixed-effects models to adjust for intra-surgeon clustering and anthropometrics. Results The RULA score was significantly lower in the RATS (4.7±0.5) compared to VATS-group (7.0±0.6) ( p < 0.001), indicating a high ergonomic risk for surgeons in the VATS-group, versus a low-to-medium risk in the RATS-group. The mean joint angles of neck, trunk, neck-tilt and shoulder-tilt were significantly higher in VATS ( p < 0.001), while the elbow angles were significantly greater in RATS ( p < 0.001). There was no significant intergroup difference regarding shoulder angles ( p = 0.21) or operative time ( p = 0.53). A within-surgeon subgroup analysis confirmed these postural advantages are intrinsically driven by the robotic platform. Inter-software agreement between the tracking platforms was excellent (mean intraclass correlation coefficient = 0.94). Conclusions RATS demonstrated superior ergonomics and posture compared to VATS, with lower associated risk of musculoskeletal disorders. Integrating ergonomic checklists into surgical training is essential to minimize occupational injury risks.