Ergonomics in Minimal Access Surgery

  • Selman UranuesEmail author
  • James Elvis Waha
  • Abe Fingerhut
  • Rifat Latifi


Ergonomics – the study of human efficiency in the workplace – began empirically when humans first started to use tools and find ways to make them easier and more efficient to work with. Only in the mid-nineteenth century did ergonomics begin to emerge as a formal science that has since gained importance in every field of human endeavor that involves a man/machine interface, including surgery. Though surgeons have always been susceptible to work-related musculoskeletal disorders, following the introduction in recent decades of a proliferation of minimal access and robotic surgical technologies, serious attention is finally being given to the relationship of surgical ergonomics and the surgeon’s health.


Ergonomics Minimally invasive surgery Minimal access surgery Robotic surgery Laparoscopic surgery 



The authors gratefully acknowledge the assistance of Eugenia Lamont in performing the literature search and drafting the text.

Further, the authors thank Martin Stelzer, medical photographer and illustrator at the Medical University of Graz, for illustrations and for providing Fig. 20.1a for this chapter.


  1. 1.
    Jastrzębowski WB. An outline of ergonomics, or the science of work based upon the truths drawn from the Science of Nature: 1857. Central Institute for Labour Protection. Warsaw: Central Institute for Labour Protection; 2000.Google Scholar
  2. 2.
    Shah J. Endoscopy through the ages. BJU Int. 2002;89:645–52.CrossRefGoogle Scholar
  3. 3.
    Cutner A, Stavroulis A, Zolfaghari N. Risk assessment of the ergonomic aspects of laparoscopic theatre. Gynecol Surg. 2013;10:99–102.CrossRefGoogle Scholar
  4. 4.
    Fingerhut A, Hanna GB. Ergonomics of the minimally invasive operating theatre. In: Bonjer HJ, editor. Surgical principles of minimally invasive procedures: Springer International New York City; 2017.
  5. 5.
    Franasiak JM, Gehrig PA. Ergonomic strain in minimally invasive surgery: addressing the strain epidemic. JCOM. 2015;22(6):267–73.Google Scholar
  6. 6.
    Park A, Lee G, Meenaghan N, Dexter D. Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg. 2010;210(3):306–13.CrossRefGoogle Scholar
  7. 7.
    Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhai D, Lee BT. Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg. 2018;153(2):e174947.CrossRefGoogle Scholar
  8. 8.
    Stucky CCH, Cromwell KD, Voss RK Chaing YJ, Woodman K. Surgeon symptoms, strain and selections: systematic review and meta-analysis of surgical ergonomics. Ann Med Surg. 2018;27:1–8.CrossRefGoogle Scholar
  9. 9.
    Janki S, Mulder EEAP, IJzermans JNM. Ergonomics in the operating room. Surg Endosc. 2017;31:2457–66.CrossRefGoogle Scholar
  10. 10.
    Hubert N, Gilles M, Desbrosses K, Meyer JP, Felbinger J, Hubert J. Ergonomic assessment of the surgeon’s physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot. 2013;9(2):142–7.CrossRefGoogle Scholar
  11. 11.
    Elhage O, Challacombe B, Shortland A, Dasgupta P. An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int. 2015;115:274–81.CrossRefGoogle Scholar
  12. 12.
    Pierhoples TA, Hernandez-Boussard T, Wren SM. The aching surgeon: a survey of physical discomfort and symptoms following open, laparoscopic, and robotic surgery. J Robot Surg. 2012;6(1):65–72.CrossRefGoogle Scholar
  13. 13.
    Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR. Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc. 2014;28:456–65.CrossRefGoogle Scholar
  14. 14.
  15. 15.
    Blikkendaal MD, Driessen SRC, Rodrigues SP, Rhemrev JPT, Smeets MJGH, Dankelman J, van den Dobbelsteen JJ, Jansen FW. Measuring surgical safety during minimally invasive surgical procedures: a validation study. Surg Endosc. 2018;32(7):3087–95.Google Scholar
  16. 16.
    Shankar M, Manjunath K, Krishnappa R. Ergonomics in laparoscopy: a questionnaire survey of physical discomfort and symptoms in surgeons following laparoscopic surgery. Int Surg J. 2017;4:3907–14.CrossRefGoogle Scholar
  17. 17.
    van Det MJ, Meijerink WJHJ, Hoff C, Totté ER, Pierie JPEN. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc. 2009;23:1279–85.CrossRefGoogle Scholar
  18. 18.
    Chui A, Bowne WB, Sookraj KA, Zenilman ME, Fingerhut A, Ferzli GS. The role of the assistant in laparoscopic surgery: important considerations for the apprentice-in-training. Surg Innov. 2008;15:229–36.CrossRefGoogle Scholar
  19. 19.
    Marescaux J, Diana M. Looking at the future with an augmented eye. Ann Laparosc Endosc Surg. 2016;1:36–42.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Selman Uranues
    • 1
    Email author
  • James Elvis Waha
    • 2
  • Abe Fingerhut
    • 3
  • Rifat Latifi
    • 4
  1. 1.Department of Surgery, Section for Surgical ResearchMedical University of GrazGrazAustria
  2. 2.Department of Surgery, Division of General SurgeryMedical University of GrazGrazAustria
  3. 3.Surgical Research, Surgical DepartmentUniversity of GrazGrazAustria
  4. 4.New York Medical College, School of Medicine, Department of Surgery and Westchester Medical CenterValhallaUSA

Personalised recommendations