Revealing the ergonomic crisis of upper gastrointestinal robotic surgery - still a lot to improve in minimally invasive surgery

Introduction Minimally invasive technologies have improved outcomes after esophagectomy and the use of robotic technology in Europe is rapidly increasing. Even if robotic technology was developed to improve minimally invasive surgery, many robotic surgeons complain about ergonomics when using existing devices.

Aim Aim of this study is to evaluate the ergonomics of the newest robotic technology in a center of excellence for upper gastrointestinal surgery.

Methods Starting 02/2017 the latest available robotic system (davinci xi) was introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n>300 esophageal cases/year). Surgeons ergonomics were studied using a standardized video capture and touch sensor protocol [Fig 1]. Data recorded were analyzed to study whether the new robotic system was used in an ergonomic fashion throughout robotic esophageal surgery.

Results From 02/2017 - 09/2019, a total of 105 mainly upper gastrointestinal robotic cases including 52 Esophagectomies for cancer and 25 Heller Myotomies were performed. All cases were performed safely without operation-associated intraoperative complications.

Even though experienced robotic console surgeons used the robotic device, the davinci xi arm rest was used in less than 25% of surgery time [Fig. 2] Video documentation using the new technology is provided to showcase the dilemma.

Conclusion Robotic technology allows for safe minimally invasive upper gastrointestinal operations. Further development in robotics should focus on improvement of surgeons ergonomics.

▶Fig. 1 Standardized video capture and and touch sensor protocol.

▶Fig. 2

Publication History

Article published online:
08 September 2020