Valorenzos Alexandros, Nielsen Kristian Als, Helligsø Per, Nielsen Michael Festersen, Wolfgang Philip, Thomsen Gert Frank, Dalager Tina
Department of General Surgery, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Surg Endosc. 2025 May;39(5):3095-3105. doi: 10.1007/s00464-025-11676-7. Epub 2025 Mar 31.
Robotic-assisted and laparoscopic techniques are widely used for inguinal hernia repair. While robotic-assisted transabdominal preperitoneal (rTAPP) repair is believed to offer ergonomic advantages for surgeons, there is limited evidence comparing its ergonomic impact to conventional laparoscopic TAPP (cTAPP) repair. This study aims to assess the ergonomic strain on surgeons during these procedures using subjective and objective measures.
This crossover observational study involved four experienced hernia surgeons who performed two procedures using each technique. Ergonomic strain was evaluated through self-reported perceived exertion (using the Borg scale), surface electromyography (sEMG) of select muscle groups, and posture analysis using rapid upper limb assessment (RULA) scores derived from kinematic data collected via Xsens Awinda. Statistical comparisons were conducted using the Wilcoxon rank-sum test, with adjustments for multiple comparisons.
Subjectively, surgeons perceived rTAPP as less physically demanding, with lower postoperative perceived exertion scores (median 1.5 vs. 3.0, p < 0.01). Objective measurements showed higher static muscle activity in the left erector spinae and median activity in the right trapezius during rTAPP (p = 0.016), but overall ergonomic strain, as indicated by RULA scores, was similar across modalities. Median RULA scores for both techniques were 3, and no significant differences were observed in work posture scores. Despite these findings, discomfort during cTAPP was more frequently reported, with surgeons citing the neck, shoulders, and lower back as affected areas.
While rTAPP was subjectively perceived as less physically demanding, objective metrics did not corroborate these perceptions, showing comparable ergonomic strain between techniques. These findings highlight a complex relationship between subjective and objective ergonomic measures and suggest a need for further research, incorporating broader assessments of cognitive and physical loads, to optimize surgeon ergonomics in minimally invasive procedures.
机器人辅助和腹腔镜技术广泛用于腹股沟疝修补术。虽然机器人辅助经腹腹膜前（rTAPP）修补术被认为对外科医生具有人体工程学优势，但将其与传统腹腔镜TAPP（cTAPP）修补术的人体工程学影响进行比较的证据有限。本研究旨在使用主观和客观测量方法评估这些手术过程中外科医生的人体工程学压力。
这项交叉观察性研究纳入了四位经验丰富的疝外科医生，他们分别使用每种技术进行了两种手术。通过自我报告的主观用力程度（使用Borg量表）、选定肌肉群的表面肌电图（sEMG）以及使用通过Xsens Awinda收集的运动学数据得出的快速上肢评估（RULA）分数进行姿势分析，来评估人体工程学压力。使用Wilcoxon秩和检验进行统计比较，并对多重比较进行调整。
主观上，外科医生认为rTAPP的体力要求较低，术后主观用力程度得分较低（中位数为1.5对3.0，p < 0.01）。客观测量显示，在rTAPP过程中，左侧竖脊肌的静态肌肉活动较高，右侧斜方肌的平均活动较高（p = 0.016），但根据RULA分数表明，总体人体工程学压力在两种方式之间相似。两种技术的RULA中位数分数均为3，工作姿势分数未观察到显著差异。尽管有这些发现，但cTAPP期间的不适报告更为频繁，外科医生指出颈部、肩部和下背部是受影响的区域。
虽然主观上认为rTAPP的体力要求较低，但客观指标并未证实这些看法，表明两种技术之间的人体工程学压力相当。这些发现凸显了主观和客观人体工程学测量之间的复杂关系，并表明需要进一步研究，纳入对认知和身体负荷的更广泛评估，以优化微创手术中的外科医生人体工程学。
