Comparing the Musculoskeletal Demands of Surgeons Performing Robotic-assisted Laparoscopic Surgery and Standard Laparoscopic Surgery

The number of surgical procedures being performed using minimal access techniques is on the rise because of improved recovery times for patients. Thus, surgeons are performing an increasing number of endoscopic/laparoscopic procedures and are operating for longer periods. A recent meta-analysis showed that work-related musculoskeletal injuries amongst surgeons are common (1) and surgeons are amongst those most at risk of work-related musculoskeletal decline (2). Indeed, the prevalence of degenerative spinal disease is 17%, rotator cuff pathology 18%, and degenerative lumbar spine disease is 19% (1). Surgeon's experience work-related musculoskeletal pain in addition to injury, and pain is highly prevalent in the neck (48%), shoulder (43%), and back (50%) (13).

According to the Office for National Statistics in the UK, musculoskeletal problems amongst the workforce are the second most common cause for absence (17.7%) and account for 23 days absence/year (2). This is not dissimilar in the US where the Bureau of Labour Statistics estimates that 62% of all worker injuries and 32% of missed days from work result from musculoskeletal problems. Collectively, these data suggest that musculoskeletal problems caused by careers in surgery can reduce physical health, which is associated with reduced productivity, career longevity, and even the quality of patient care.

Robotic-assisted laparoscopic surgery (RALS) is a modern technology that could help mitigate these musculoskeletal problems and thereby improve patient care. In comparison to standard laparoscopic surgery (LS), RALS offers steadier wrist movements with a reduced fulcrum effect, thus benefiting the patient (3). There is emerging evidence that RALS is associated with a lower rate of musculoskeletal problems (23-80%) than LS (70- 100%) (1). RALS may therefore be an attractive alternative to LS, despite the high cost of equipment and steep learning curve during training.

No study has compared the demands of RALS vs. LS on musculoskeletal fatigue (and subsequent injury risk) and whether these changes are underpinned by changes in cognitive fatigue. The investigators aim to determine whether a career using RALS is associated with better musculoskeletal health for surgeons than standard LS when performing complex minimally invasive procedures.

The hypothesis is that RALS will reduce musculoskeletal fatigue and the prevalence of musculoskeletal injury in surgeons compared to LS. If this is true, RALS should receive increased support through preserving surgeon's health and thereby reducing costs for healthcare providers.