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. 2025 Sep 8.
doi: 10.1007/s00464-025-12136-y. Online ahead of print.

Evaluation of posture in four different robotic surgical systems

Dolores T Krauss  1 , Stefanie Brunner  1 , Jennifer A Eckhoff  1 , Christian Storms  1 , Benjamin Babic  2 , Thomas Schulz  3 , Lorenzo Macone  1 , Jun Kinoshita  4 , Kengo Hayashi  4 , Saki Hayashi  4 , Thomas Schmidt  1 , Christiane J Bruns  1 , Hans F Fuchs  5
Affiliations

Evaluation of posture in four different robotic surgical systems

Dolores T Krauss et al. Surg Endosc. .

Abstract

Background: While many ergonomic challenges traditionally faced in open and laparoscopic surgery have been overcome by robotic surgery, new challenges have been created. This study aims to identify and compare the ergonomic characteristics of a variety of robotic systems to ultimately lay the foundation for ergonomic guidelines.

Methods: Measurements evaluating the surgeon and their interaction with the new technology were applied in either a laboratory or a real-life setting. A video camera was used to capture the surgeon at the console during surgery. For evaluation of the images, axes were placed along the joints of the surgeon. Corresponding angles were calculated based on the position of the individual axes in relation to each other and compared to recommendations for a healthy workspace.

Results: A total of 13 surgeries were measured during actual cases using the DaVinci with a total of n = 20,250 pictures used for analysis; 2 surgeries were measured using the Dexter, with a total of 1,994 pictures used for analysis; 17 measurements were taken with the Hugo™ RAS System in a simulation setting, with a total of 1,179 pictures used for analysis. In addition, a total of 327 pictures from a simulation setting were used for analysis of the Hinotori. Corresponding angles for knee, elbow, and back were within recommendations for all systems; hip angles were not within recommendations for any system, and the neck posture was only within recommendations for the Hinotori.

Conclusion: A variety of different robotic systems differ in ergonomic requirements. The neck can be identified as an area of need for improvement for most systems. Future studies, particularly in a randomized controlled fashion, need to be performed to further analyze ergonomic features of the different systems, and guidelines displaying the variety of systems need to be implemented to create a healthy and safe workplace.

Keywords: DaVinci surgical system; Dexter surgical system; Ergonomics; Hinotori surgical system; Hugo surgical system; Robotic surgery.

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