Ergonomic impact of open- versus closed-console robotic systems on surgeon fatigue and musculoskeletal strain: A prospective, experimental, wet-lab comparative study

Abstract Introduction: Robotic-assisted surgery has transformed minimally invasive surgery by enhancing dexterity, visualisation and surgeon ergonomics. However, significant variations exist in robotic console architecture, primarily between open-console and closed-console systems. Although robotic surgery is generally considered to offer ergonomic benefits over laparoscopic surgery, evidence comparing ergonomic outcomes between console designs remains limited. To compare the ergonomic impact of open- versus closed-console robotic systems on surgeon fatigue, musculoskeletal strain and workload. Patients and Methods: A prospective, randomised, crossover wet-lab study was conducted involving surgeons performing standardised robotic surgical tasks on both open-console and closed-console robotic systems. Ergonomic outcomes were assessed using Rapid Upper Limb Assessment (RULA), NASA Task Load Index (NASA-TLX) and subjective fatigue scales. Results: Open-console systems demonstrated significantly lower RULA scores and improved ergonomic posture compared with closed-console systems ( P < 0.05). Surgeons reported reduced neck, shoulder and upper back discomfort after open-console use. NASA-TLX scores revealed lower physical demand, effort and frustration with open-console systems. No statistically significant difference in surgical precision or error rates was observed between the systems. Conclusion: Open-console robotic systems provide superior ergonomic advantages compared with closed-console robotic systems, reducing surgeon fatigue and musculoskeletal strain without compromising technical performance. Console architecture should be recognised as a major determinant of surgeon occupational health and future robotic platform design.