The challenges of laparoscopy have been attributed to the short-comings in the design of conventional instruments, and the awkward posturing adopted by operators for protracted periods of surgery. Most laparoscopic instruments incorporate a ringed pistol-type handle that results in excessive flexion and deviation of the surgeon’s wrist during tissue manipulation. The hand-to-tip force transmission is also less efficient compared to the instruments used in open surgery. (10,11) The visual display of the operative field is also paramount to the conduct of laparoscopic surgery. While three-dimensional scope systems have been introduced in an attempt to address the lack of stereopsis, many of these still suffer from limitations, such as the loss of light intensity as a result of using polarized glasses. (12) Coupled with the need to constantly focus the image on a dynamically moving surgical instrument, a trained scope assistant is invaluable to the smooth conduct of complex laparoscopic surgeries. Robotic surgical systems have been designed to address these issues. Not only does the robotic system reduce the reliance on a trained assistant, it also provides greater surgeon comfort, autonomy and improved fluidity of surgical motion. (13–15) Newer generation scopes also provide superior image quality and depth perception.
Our results show that the amount of physical fatigue after laparoscopy is significantly more, affecting both hands of the surgeon. However, the dexterity and presumable overall performance of the surgeon was not impaired. This could be because the PBT did not require significant motor power to complete, and perhaps the hand-eye coordination of an experienced MIS surgeon was able to compensate for the loss of strength. Alternatively, the complexity of the cases performed laparoscopically might not have been enough to stress the surgeon, or this might not have been apparent after only two hours of operating, taking into account that the timing also included less demanding tasks like port placement. Conversely, it could be argued that the use of robotics mitigated the amount of fatigue experienced by the surgeon even in complex colorectal operations, given that the majority of the robotic cases were either low anterior resection or transanal procedures. Given the demands of complex colorectal surgeries and high-volume workload, robotics may be a means of optimizing surgeon performance by reducing fatigue. (16) This would expectedly help to reduce iatrogenic injuries and mistakes caused by human error, and possible justify the added expense of robotic technology.
As this was a pilot study evaluating the feasibility of such a method of assessment, out analysis inevitable suffers from the limitations of a small sample size. In addition, operator posture and arm positions during surgery were not recorded, although these were assumed to have been ergonomically ideal given the experience of the surgeon studied. While the study of a single surgeon’s ergonomics allowed comparability across the two MIS platforms, it also limited the generalizability of our findings. The results may also differ from surgeons who utilize different laparoscopic and robotic equipment from our institution.