Home > Research > Publications & Outputs > Should all minimal access surgery be robot-assi...

Associated organisational unit

Electronic data

  • Shugaba et al_manuscript_post_review_1

    Rights statement: The final publication is available at Springer via http://dx.doi.org/10.1007/s11605-022-05319-8

    Accepted author manuscript, 538 KB, PDF document

    Available under license: CC BY-NC: Creative Commons Attribution-NonCommercial 4.0 International License


Text available via DOI:

View graph of relations

Should all minimal access surgery be robot-assisted?: A systematic review into the musculoskeletal and cognitive demands of laparoscopic and robot-assisted laparoscopic surgery

Research output: Contribution to Journal/MagazineJournal articlepeer-review

<mark>Journal publication date</mark>31/07/2022
<mark>Journal</mark>Journal of Gastrointestinal Surgery
Issue number7
Number of pages11
Pages (from-to)1520-1530
Publication StatusPublished
Early online date14/04/22
<mark>Original language</mark>English


Background: Surgeons are amongst the most at risk of work-related musculoskeletal health decline because of the physical demands of surgery, which is also associated with cognitive fatigue. Minimally invasive surgery offers excellent benefits to patients but the impact of robotic or laparoscopic surgery on surgeon well-being is less well understood. This work examined the musculoskeletal and cognitive demands of robot-assisted versus standard laparoscopic surgery.
Methods: Medline, Embase, and Cochrane databases were systematically searched for “Muscle strain” AND “musculoskeletal fatigue” AND “occupational diseases” OR “cognitive fatigue” AND “mental fatigue” OR “standard laparoscopic surgery” AND “robot-assisted laparoscopic surgery”. Primary outcomes measured were electromyographic (EMG) activity for musculoskeletal fatigue and questionnaires (NASA TLX, SMEQ, or Borg CR-10) for cognitive fatigue. A systematic review was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) Guidelines. The study was preregistered on Prospero ID: CRD42020184881.
Results: Two hundred and ninety-eight original titles were identified. Ten studies that were all observational studies were included in the systematic review. EMG activity was consistently lower in robotic than in laparoscopic surgery in the erector spinae and flexor digitorum muscles but higher in the trapezius muscle. This was associated with significantly lower cognitive load in robotic than laparoscopic surgery in 7 of 10 studies.
Conclusions: Evidence suggests a reduction in musculoskeletal demands during robotic surgery in muscles excluding the trapezius, and this is associated with most studies reporting a reduced cognitive load. Robotic surgery appears to have less negative cognitive and musculoskeletal impact on surgeons compared to laparoscopic surgery.

Bibliographic note

The final publication is available at Springer via http://dx.doi.org/10.1007/s11605-022-05319-8