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The DEXTER Robotic Surgery System offers an open concept where the surgeon console can be used in a sterile manner, allowing flexibility to switch between the robotic system and conventional laparoscopy. The aim of this study was to evaluate surgical ergonomics during the use of the DEXTER Robotic System.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective, non-randomized international multicenter trial evaluating surgical ergonomics during the routine clinical practice was performed in Switzerland and USA. A photo camera captured the surgeon\u2019s posture at the console during surgery. Using picture editing programs, image analyses were created showing the surgeon\u2019s average posture and corresponding angles. Furthermore, sound levels were measured during cases. Data were compared to previous measurements (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200933 surgeries) of a closed console robotic system using the same methodology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 83,025 images from 40 surgical procedures were analyzed, performed by five surgeons. Knee, back, and elbow angles were within recommended ergonomic limits whereas neck and hip positions were classified as high-risk. Compared with a closed console robotic system, neck posture was significantly improved (\n                      <jats:italic>p<\/jats:italic>\n                      value 0.0001). Mean sound levels were 60.24\u00a0dB for all surgeries. Comparison to a robotic system with a closed console revealed a statistically quieter OR setting for the open DEXTER system (mean sound level 64.35\u00a0dB vs. 59.5\u00a0dB;\n                      <jats:italic>p<\/jats:italic>\n                      value 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The application of ergonomic measurements during a real-life setting for robotic surgery helped to reveal ergonomic advantages and challenges faced when using a new robotic technology. This is the first study providing ergonomic insights in the DEXTER surgical system, identifying individual possibilities for improvement. Future studies and recommendations will may lay the foundation for a personalized training and education in surgical ergonomics leading to a healthier workspace for all surgeons and their future careers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-13251-0","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:37:44Z","timestamp":1785767864000},"page":"9026-9033","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of ergonomics using the DEXTER\u00ae Robotic Surgery System: the ERGODEX trial"],"prefix":"10.1007","volume":"40","author":[{"given":"Dolores T.","family":"Krauss","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Krones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Abry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiana","family":"Castronovo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Eckhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Brunner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Babic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marietta","family":"Gulz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nico","family":"Seeger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan C","family":"Broderick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Thareja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane J.","family":"Bruns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans F.","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"13251_CR1","doi-asserted-by":"publisher","first-page":"235","DOI":"10.2214\/AJR.157.2.1830188","volume":"157","author":"JC Brandon","year":"1991","unstructured":"Brandon JC, Velez MA, Teplick SK, Mueller PR, Rattner DW, Broadwater JR, Lang NP, Eidt JF (1991) Laparoscopic cholecystectomy: evolution, early results, and impact on nonsurgical gallstone therapies. 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Dr. Eckhoff disclosed a DFG and Olympus research grant outside this study. Prof. Bruns received research support and speaker\u2019s fees from Medtronic and Intuitive and consultancy fees from Medtronic, all unrelated to this study. Prof. Fuchs is a member of the advisory board of Medtronic and\u00a0Distalmotion and is a consultant for Stryker Corporation. He received an educational grant from intuitive surgical (ESOMAP trial) and receives compensation for EAES robotic teaching courses, all unrelated to this study. Dr. Brunner, Ms. Krones, Dr. Abry, Dr. Castronovo, Dr. Babic, Prof. M\u00fcller, Dr. Gulz, Dr. Seeger, Dr. Broderick, and Dr. Thareja have no conflicts of interest or financial ties to disclose.","order":1,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}}]}}