Enhancing ergonomics in robotic surgery—a review

Abstract

Abstract: The field of ergonomics is composed of three main domains: physical, cognitive, and organisational. The ergonomic advantages of robotic surgery (RS) have been well described in many studies. The majority of published studies on ergonomics and RS have not investigated interventions which may enhance the known ergonomic advantages or overcome the ergonomic disadvantages. This review will report on interventions during RS which can reduce visual fatigue, reduce musculoskeletal pain, enhance manipulation of robotic instruments (including avoidance of robotic arm clashes), offer haptic feedback, improve robotic skills to improve efficiency, improve cognition, and overcome workflow disruptions. Downgaze positioning, regular screen breaks, eye relaxation exercises, refractive error correction, lubricating eye drops use, and blink efficiency are interventions which have been used to reduce visual fatigue. Ergonomic training to encourage more frequent use of the clutch controller, taking microbreaks with targeted stretching, and resistance strengthening training are some interventions which can help reduce musculoskeletal pain. The manipulation benefits can be enhanced by optimal port placement and avoidance of external clashes. Addition of haptic feedback can improve precision and reduce grasping forces. Robotic surgical simulator training, coaching/proctoring, and video review are some methods which can enhance robotic skills and shorten the learning curve. Cognitive training can improve skills during the stages of motor learning. Organisational interventions can overcome workflow disruptions related to surgeon separation and reduced situation awareness.