Surgical Endoscopy

, Volume 32, Issue 5, pp 2533–2540 | Cite as

Validation of ergonomic instructions in robot-assisted surgery simulator training

  • C. D. P. Van’t Hullenaar
  • A. C. Mertens
  • J. P. Ruurda
  • I. A. M. J. Broeders



Training in robot-assisted surgery focusses mainly on technical skills and instrument use. Training in optimal ergonomics during robotic surgery is often lacking, while improved ergonomics can be one of the key advantages of robot-assisted surgery. Therefore, the aim of this study was to assess whether a brief explanation on ergonomics of the console can improve body posture and performance.


A comparative study was performed with 26 surgical interns and residents using the da Vinci skills simulator (Intuitive Surgical, Sunnyvale, CA). The intervention group received a compact instruction on ergonomic settings and coaching on clutch usage, while the control group received standard instructions for usage of the system. Participants performed two sets of five exercises. Analysis was performed on ergonomic score (RULA) and performance scores provided by the simulator. Mental and physical load scores (NASA-TLX and LED score) were also registered.


The intervention group performed better in the clutch-oriented exercises, displaying less unnecessary movement and smaller deviation from the neutral position of the hands. The intervention group also scored significantly better on the RULA ergonomic score in both the exercises. No differences in overall performance scores and subjective scores were detected.


The benefits of a brief instruction on ergonomics for novices are clear in this study. A single session of coaching and instruction leads to better ergonomic scores. The control group showed often inadequate ergonomic scores. No significant differences were found regarding physical discomfort, mental task load and overall performance scores.


Robot Ergonomics Training Minimally invasive surgery 



Many thanks to the residents and interns at the Department of Surgery for their cooperation in this research project.

Compliance with ethical standards


Broeders is a Proctor at Intuitive Surgery. Van’t Hullenaar, Mertens, and Ruurda have no conflicts of interest or financial ties to disclose.

Supplementary material

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • C. D. P. Van’t Hullenaar
    • 1
  • A. C. Mertens
    • 1
    • 2
  • J. P. Ruurda
    • 2
  • I. A. M. J. Broeders
    • 1
  1. 1.Department of SurgeryMeander Medical CenterAmersfoortThe Netherlands
  2. 2.Department of SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands

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