A comprehensive PLOS One scoping review analyzed 94 studies using electromyography (EMG) to objectively measure muscle activity during laparoscopic and robot-assisted surgery. Most studies focused on conventional laparoscopy, while robotic surgery data remained comparatively limited and methodologically diverse.

Key Findings

Across comparative studies:

• Robotic surgery generally produced lower upper-body muscle activation, particularly in the neck, shoulders, and upper back.
• Conventional laparoscopy generated greater static muscle loading due to prolonged arm elevation and awkward posture.
• Considerable variation existed in EMG protocols, muscle groups evaluated, task design, and data normalization methods.

The authors conclude that although robotics appears ergonomically advantageous, current evidence is insufficient to confirm that robotic platforms prevent long-term occupational musculoskeletal disorders.

Clinical Significance

Unlike subjective surveys, EMG provides objective physiological measurement of surgeon workload. Future applications may include simulator-based ergonomic training, operating-room workstation optimization, and comparison of surgical platforms using standardized objective metrics.

Clinical Relevance

For laparoscopic and robotic surgeons, musculoskeletal injury remains a major occupational hazard. This review supports incorporating ergonomic assessment into surgical education while emphasizing that good posture, appropriate monitor positioning, and optimized operating-room setup remain essential regardless of the surgical platform.

Source: https://pubmed.ncbi.nlm.nih.gov/42545985/

Scoping Review Highlights Need for Standardized Ergonomic Assessment in Minimally Invasive Surgery

A second Surgical Endoscopy scoping review evaluated 99 published studies investigating surgeon ergonomics during minimally invasive surgery.

Among these:

• 60 studies focused on laparoscopy.
• 36 studies evaluated robotic surgery.

The review categorized ergonomic assessment methods into:

• Self-reported questionnaires.
• Observational posture analysis.
• Instrument-based objective measurements.
• Computer-assisted ergonomic analysis.

Key Findings

Physical ergonomics was most commonly assessed using:

• Posture analysis.
• Motion sensors.
• Instrumented measurements.

Cognitive workload was usually evaluated using questionnaires.

The review identified major inconsistencies in:

• Terminology.
• Study methodology.
• Measurement techniques.
• Outcome reporting.

Clinical Significance

The authors recommend development of standardized multimodal ergonomic assessment tools capable of simultaneously evaluating posture, muscle activity, fatigue, cognitive workload, and overall surgical performance.

Clinical Relevance

For minimally invasive surgery programs, ergonomics should be considered a patient safety and workforce sustainability issue rather than simply surgeon comfort. Proper monitor positioning, operating-table height, trocar geometry, instrument alignment, and ergonomic education should become routine components of laparoscopic skills training.

Source: https://pubmed.ncbi.nlm.nih.gov/42545525/

Short Microbreaks Provide Limited Protection Against Visual and Musculoskeletal Fatigue During Robotic Surgery

A randomized simulation trial from AIIMS, New Delhi investigated the effects of short microbreaks during robotic surgery training using the Hugo Robotic Assisted Surgery (RAS) platform.

Thirty-six surgical residents performed standardized robotic console tasks either continuously or with a 5-minute guided microbreak after 45 minutes.

Key Findings

Robotic console work significantly increased:

• Eye strain.
• Accommodation abnormalities.
• Convergence fatigue.
• Reduced stereoscopic vision.
• Dry-eye symptoms.
• Neck discomfort.
• Shoulder pain.
• Wrist fatigue.
• Lower back discomfort.

Microbreaks improved only selected subjective symptoms such as eye dryness and irritation.

However:

• Objective ocular measurements showed little improvement.
• Musculoskeletal discomfort remained largely unchanged.
• Mental workload was not significantly reduced.

Clinical Significance

The findings suggest that short breaks alone cannot eliminate the physical demands of prolonged robotic surgery.

Clinical Relevance

Training programs should combine workstation optimization, ergonomic coaching, regular conditioning exercises, scheduled breaks, and appropriate console adjustment to reduce occupational injury during robotic surgery.

Source: https://pubmed.ncbi.nlm.nih.gov/42545523/

Experimental Pancreatic Duct Radiofrequency Ablation May Reduce Future Pancreatic Fistula Risk

A Surgical Endoscopy experimental porcine study evaluated whether endoluminal radiofrequency ablation (RFA) of the main pancreatic duct before pancreatic transection could reduce postoperative pancreatic fistula formation.

Animals underwent pancreatic duct RFA followed by pancreatic transection four weeks later.

Key Findings

Compared with cyanoacrylate duct occlusion, radiofrequency ablation produced:

• More uniform exocrine pancreatic atrophy.
• Preservation of endocrine tissue.
• Fewer postoperative pseudocysts.
• Reduced adhesions.
• Fewer surrogate markers associated with pancreatic fistula.

Clinical Significance

Rather than modifying only the surgical reconstruction, this approach attempts to biologically alter the pancreatic remnant before surgery, potentially reducing exocrine secretion and postoperative leakage.

Clinical Relevance

Although entirely preclinical, this innovative concept may eventually complement existing techniques for preventing pancreatic fistula following pancreatoduodenectomy and distal pancreatectomy. Clinical trials will be required before any routine clinical application.

Source: https://pubmed.ncbi.nlm.nih.gov/42545521/

Large Robotic eTEP Series Reports Excellent Mid-Term Outcomes for Ventral Hernia Repair

A single-center study published in Surgical Endoscopy reported outcomes from 380 robotic extended-view totally extraperitoneal (eTEP) ventral and incisional hernia repairs.

Key Findings

Results included:

• Fascial closure achieved in 99.5%.
• Only two conversions to open surgery.
• Surgical-site infection rate of 1.6%.
• Median hospital stay of 1 day.
• Surgical-site occurrences were primarily seromas.
• Estimated 2-year recurrence rate: 4.4%.

Clinical Significance

Robotic eTEP combines minimally invasive access with retromuscular mesh placement and anatomical abdominal wall reconstruction while avoiding intraperitoneal mesh positioning.

Clinical Relevance

The findings support robotic eTEP as an effective abdominal wall reconstruction technique in experienced centers. Surgeons should continue counselling patients regarding postoperative seroma formation while recognizing that outcomes remain influenced by case selection, institutional expertise, and the learning curve.

Source: https://pubmed.ncbi.nlm.nih.gov/42545520/

Left-Sided Gallbladder Remains Rare but Demands Strict Adherence to Safe Cholecystectomy Principles

A Korean 12-year retrospective review examined 7,487 laparoscopic cholecystectomies and identified 23 patients with a left-sided gallbladder, representing an incidence of approximately 0.3%.

Key Findings

• None of the anomalies were diagnosed preoperatively.
• Operative duration was comparable with normal anatomy.
• Gallbladder perforation rates were similar.
• No bile duct injuries occurred.
• No increase in postoperative complications was observed.

Clinical Significance

Although technically feasible using standard laparoscopic techniques, left-sided gallbladder is frequently associated with unexpected biliary and vascular anatomical variations.

Clinical Relevance

Whenever Calot's triangle anatomy appears unusual, surgeons should slow dissection, re-establish the Critical View of Safety, consider intraoperative cholangiography or fluorescence imaging, and maintain a low threshold for altering technique or converting to an open approach when anatomical uncertainty persists.

Source: https://pubmed.ncbi.nlm.nih.gov/42544054/

Key Takeaway

Today's evidence highlights the growing importance of surgeon ergonomics, occupational health, standardized operative techniques, and innovative technologies in minimally invasive surgery. Objective ergonomic assessment, optimized robotic workstations, advanced abdominal wall reconstruction, experimental strategies for pancreatic fistula prevention, and unwavering commitment to safe anatomical dissection continue to improve both surgeon performance and patient outcomes.