Evaluation of ergonomics using the DEXTER® Robotic Surgery System: the ERGODEX trial

BACKGROUND: The implications of complex robotic surgery on the well-being of surgeons remains widely unexplored. The DEXTER Robotic Surgery System offers an open concept where the surgeon console can be used in a sterile manner, allowing flexibility to switch between the robotic system and conventional laparoscopy. The aim of this study was to evaluate surgical ergonomics during the use of the DEXTER Robotic System. METHODS: A prospective, non-randomized international multicenter trial evaluating surgical ergonomics during the routine clinical practice was performed in Switzerland and USA. A photo camera captured the surgeon's posture at the console during surgery. Using picture editing programs, image analyses were created showing the surgeon's average posture and corresponding angles. Furthermore, sound levels were measured during cases. Data were compared to previous measurements (n = 33 surgeries) of a closed console robotic system using the same methodology. RESULTS: A total of 83,025 images from 40 surgical procedures were analyzed, performed by five surgeons. Knee, back, and elbow angles were within recommended ergonomic limits whereas neck and hip positions were classified as high-risk. Compared with a closed console robotic system, neck posture was significantly improved (p value 0.0001). Mean sound levels were 60.24 dB for all surgeries. Comparison to a robotic system with a closed console revealed a statistically quieter OR setting for the open DEXTER system (mean sound level 64.35 dB vs. 59.5 dB; p value 0.0001). CONCLUSION: The application of ergonomic measurements during a real-life setting for robotic surgery helped to reveal ergonomic advantages and challenges faced when using a new robotic technology. This is the first study providing ergonomic insights in the DEXTER surgical system, identifying individual possibilities for improvement. Future studies and recommendations will may lay the foundation for a personalized training and education in surgical ergonomics leading to a healthier workspace for all surgeons and their future careers.