{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:33:52Z","timestamp":1784774032013,"version":"3.55.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"European Society of Thoracic Surgeons"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Motion tracking tools have been used in the analysis of surgeons\u2019 technical expertise and posture in simulated endoscopic surgery. But its use in humans in real-life robotic surgery is limited. We analysed the effect of surgeons\u2019 ergonomics and posture on skill metrics for vascular dissection during anatomical pulmonary resection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this observational study of vascular dissection\/division during segmentectomy or lobectomy, we analysed the inter-group differences of those with more than (group 1) and less than (group 2) 100 robotic resections. The rapid upper limb assessment (RULA) scale was used to estimate ergonomic risk. Operative performance and posture for RULA were measured using the Kinovea-0.9.5 system. Path length of moving instruments, instrument speed, time for task completion, and duration of instruments out of vision were calculated to objectively assess operator performance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Group 1 (expert) comprised 2 males and 1 female, aged 42-61\u2009years. Group 2 (novice) comprised 4 males, aged 31-52\u2009years. Sixty-seven patients underwent robotic anatomical resection using the da Vinci Xi robotic platform, with 180 pulmonary vessels isolations\/divisions (Group 1\u2009=\u200995 vs Group 2\u2009=\u200985). Group 1 had significantly better RULA ergonomic scores (4.3 vs 4.7, P\u2009&amp;lt;\u2009.001) which was associated with higher speed (2.8\u2009\u00b1\u20090.8 vs 2.1\u2009\u00b1\u20090.2\u2009cm\/s, P\u2009&amp;lt;\u2009.001), shorter task completion time (388\u2009\u00b1\u2009278 vs 520\u2009\u00b1\u2009322\u2009s, P\u2009=\u2009.001), and shorter duration of instruments out of vision (P\u2009&amp;lt;\u2009.001). There was no difference in path length (P\u2009=\u2009.8) and no significant correlation between RULA score and different parameters that assessed surgical performance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Video motion tracking software is an effective and unobtrusive method to evaluate surgical ergonomics and performance in robotic surgery. Better ergonomics were associated with increased surgical experience and improved surgical performance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf180","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T16:36:20Z","timestamp":1753806980000},"source":"Crossref","is-referenced-by-count":2,"title":["Objective Assessment of Ergonomics and Performance of Thoracic Surgeons During Real-Life Anatomical Robotic Pulmonary Resections"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0491-0365","authenticated-orcid":false,"given":"Ahmed G","family":"Elkhouly","sequence":"first","affiliation":[{"name":"Cardiothoracic Surgery Department, Tanta University , Tanta 31111,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4653-8693","authenticated-orcid":false,"given":"Gowthanan","family":"Santhirakumaran","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6890-5007","authenticated-orcid":false,"given":"Ben","family":"Shanahan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4103-6061","authenticated-orcid":false,"given":"Tim","family":"Batchelor","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4755-2473","authenticated-orcid":false,"given":"Henrietta","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3058-496X","authenticated-orcid":false,"given":"David","family":"Waller","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9278-716X","authenticated-orcid":false,"given":"Steven","family":"Stamenkovic","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1417-2132","authenticated-orcid":false,"given":"Kelvin","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"2025081218220636500_ivaf180-B1","doi-asserted-by":"crossref","first-page":"2533","DOI":"10.1007\/s00464-017-5959-1","article-title":"Validation of ergonomic instructions in robot-assisted surgery simulator training","volume":"32","author":"Van\u2019t Hullenaar","year":"2018","journal-title":"Surg Endosc"},{"key":"2025081218220636500_ivaf180-B2","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1093\/icvts\/ivs173","article-title":"Ergonomics in thoracoscopic surgery: results of a survey among thoracic surgeons","volume":"15","author":"Welcker","year":"2012","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025081218220636500_ivaf180-B3","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1002\/lio2.901","article-title":"Surgical ergonomics: assessment of surgeon posture and impact of training device during otolaryngology procedures","volume":"7","author":"Leung","year":"2022","journal-title":"Laryngoscope Investig Otolaryngol"},{"key":"2025081218220636500_ivaf180-B4","doi-asserted-by":"crossref","first-page":"e174947","DOI":"10.1001\/jamasurg.2017.4947","article-title":"Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis","volume":"153","author":"Epstein","year":"2018","journal-title":"JAMA Surg"},{"key":"2025081218220636500_ivaf180-B5","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1007\/s00464-016-5160-y","article-title":"Surgeons\u2019 physical discomfort and symptoms during robotic surgery: a comprehensive ergonomic survey study","volume":"31","author":"Lee","year":"2017","journal-title":"Surg. Endosc"},{"key":"2025081218220636500_ivaf180-B6","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1089\/end.2008.0556","article-title":"Ergonomics considerations of radical prostatectomy: physician perspective of open, laparoscopic, and robot-assisted techniques","volume":"23","author":"Bagrodia","year":"2009","journal-title":"J. Endourol"},{"key":"2025081218220636500_ivaf180-B7","doi-asserted-by":"crossref","first-page":"2473974X19830635","DOI":"10.1177\/2473974X19830635","article-title":"Semiautomated motion tracking for objective skills assessment in otologic surgery: a pilot study","volume":"3","author":"Kanumuri","year":"2019","journal-title":"OTO Open"},{"key":"2025081218220636500_ivaf180-B8","doi-asserted-by":"crossref","first-page":"231e","DOI":"10.1097\/PRS.0000000000001469","article-title":"Motion analysis for microsurgical training: objective measures of dexterity, economy of movement, and ability","volume":"136","author":"McGoldrick","year":"2015","journal-title":"Plast Reconstr Surg"},{"key":"2025081218220636500_ivaf180-B9","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1002\/lary.24724","article-title":"Video-based method of quantifying performance and instrument motion during simulated phonosurgery","volume":"124","author":"Conroy","year":"2014","journal-title":"Laryngoscope"},{"key":"2025081218220636500_ivaf180-B10","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s11701-018-0851-0","article-title":"Ergonomic assessment of the first assistant during robot-assisted surgery","volume":"13","author":"Van\u2019t Hullenaar","year":"2019","journal-title":"J Robot Surg"},{"key":"2025081218220636500_ivaf180-B11","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ"},{"key":"2025081218220636500_ivaf180-B12","first-page":"233","article-title":"A proposed anatomical classification of the pulmonary fissures","volume":"42","author":"Craig","year":"1997","journal-title":"J R Coll Surg Edinb"},{"key":"2025081218220636500_ivaf180-B13","doi-asserted-by":"crossref","first-page":"2994","DOI":"10.1007\/s00464-018-6023-5","article-title":"A software-based tool for video motion tracking in the surgical skills assessment landscape","volume":"32","author":"Ganni","year":"2018","journal-title":"Surg Endosc"},{"key":"2025081218220636500_ivaf180-B14","doi-asserted-by":"crossref","first-page":"3420","DOI":"10.3390\/cancers16193420","article-title":"Learning curve for robotic colorectal surgery","volume":"16","author":"Wong","year":"2024","journal-title":"Cancers (Basel)"},{"key":"2025081218220636500_ivaf180-B15","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00464-010-1281-x","article-title":"Learning curve for robotic-assisted laparoscopic colorectal surgery","volume":"25","author":"Bokhari","year":"2011","journal-title":"Surg Endosc"},{"key":"2025081218220636500_ivaf180-B16","doi-asserted-by":"crossref","first-page":"e2113","DOI":"10.1002\/rcs.2113","article-title":"A systematic review of the true benefit of robotic surgery: ergonomics","volume":"16","author":"Wee","year":"2020","journal-title":"Int J Med Robotics Comput Assist Surg"},{"key":"2025081218220636500_ivaf180-B17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.ygyno.2012.05.016","article-title":"Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery","volume":"126","author":"Franasiak","year":"2012","journal-title":"Gynecol Oncol"},{"key":"2025081218220636500_ivaf180-B18","doi-asserted-by":"crossref","first-page":"e2014.00166","DOI":"10.4293\/JSLS.2014.00166","article-title":"Feasibility and acceptance of a robotic surgery ergonomic training program","volume":"18","author":"Franasiak","year":"2014","journal-title":"JSLS"},{"key":"2025081218220636500_ivaf180-B19","first-page":"97","article-title":"Ergonomic assessment of the da Vinci console in robot-assisted surgery","volume":"2","author":"Van\u2019t Hullenaar","year":"2017","journal-title":"Innov Surg Sci"},{"key":"2025081218220636500_ivaf180-B20","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/13645700410033661","article-title":"Ergonomic problems encountered during video-assisted thoracic surgery","volume":"13","author":"Kranenburg Gossot","year":"2004","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"2025081218220636500_ivaf180-B21","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.21037\/jtd.2016.04.16","article-title":"Evaluation of surgeon\u2019s muscle fatigue during thoracoscopic pulmonary lobectomy using interoperative surface electromyography","volume":"8","author":"Yoon","year":"2016","journal-title":"J Thorac Dis"},{"key":"2025081218220636500_ivaf180-B22","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/0003-6870(93)90080-S","article-title":"RULA: a survey method for the investigation of work-related upper limb disorders","volume":"24","author":"McAtamney","year":"1993","journal-title":"Appl Ergon"},{"key":"2025081218220636500_ivaf180-B23","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.jsurg.2013.10.006","article-title":"Construct validation of the key components of fundamental skills of robotic surgery (FSRS) curriculum: a multiinstitution prospective study","volume":"71","author":"Raza","year":"2014","journal-title":"J Surg Educ"},{"key":"2025081218220636500_ivaf180-B24","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1089\/end.2009.0197","article-title":"Ergonomic evaluation and guidelines for use of the daVinci robot system","volume":"24","author":"Lux","year":"2010","journal-title":"J Endourol"},{"key":"2025081218220636500_ivaf180-B25","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.ygyno.2014.05.019","article-title":"Physician pain and discomfort during minimally invasive gynecologic cancer surgery","volume":"134","author":"McDonald","year":"2014","journal-title":"Gynecol Oncol"},{"key":"2025081218220636500_ivaf180-B26","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s11701-019-00933-2","article-title":"Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries","volume":"14","author":"Mendes","year":"2020","journal-title":"J Robot Surg"},{"key":"2025081218220636500_ivaf180-B27","doi-asserted-by":"crossref","first-page":"4279","DOI":"10.1007\/s00464-023-10076-z","article-title":"Video-based tools for surgical quality assessment of technical skills in laparoscopic procedures: a systematic review","volume":"37","author":"Gr\u00fcter","year":"2023","journal-title":"Surg Endosc"},{"key":"2025081218220636500_ivaf180-B28","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.amjsurg.2007.02.003","article-title":"A universal global rating scale for the evaluation of technical skills in the operating room","volume":"193","author":"Doyle","year":"2007","journal-title":"Am J Surg"},{"key":"2025081218220636500_ivaf180-B29","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1002\/bjs.9168","article-title":"Error rating tool to identify and analyse technical errors and events in laparoscopic surgery","volume":"100","author":"Bonrath","year":"2013","journal-title":"Br J Surg"},{"key":"2025081218220636500_ivaf180-B30","doi-asserted-by":"crossref","first-page":"2489","DOI":"10.1007\/s00464-012-2220-9","article-title":"A prospective study demonstrating the reliability and validity of two procedure-specific evaluation tools to assess operative competence in laparoscopic colorectal surgery","volume":"26","author":"Palter","year":"2012","journal-title":"Surg Endosc"},{"key":"2025081218220636500_ivaf180-B31","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1038\/s41746-022-00566-0","article-title":"Machine learning for technical skill assessment in surgery: a systematic review","volume":"5","author":"Lam","year":"2022","journal-title":"NPJ Digit Med"},{"key":"2025081218220636500_ivaf180-B32","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.wneu.2020.04.191","article-title":"Feasibility study of the low-cost motion tracking system for assessing endoscope holding skills","volume":"140","author":"Zhenzhu","year":"2020","journal-title":"World Neurosurg"},{"key":"2025081218220636500_ivaf180-B33","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s00464-010-1251-3","article-title":"Objective assessment of laparoscopic suturing skills using a motion-tracking system","volume":"25","author":"Yamaguchi","year":"2011","journal-title":"Surg Endosc"},{"key":"2025081218220636500_ivaf180-B34","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1049\/htl.2017.0064","article-title":"Can surgical simulation be used to train detection and classification of neural networks?","volume":"4","author":"Zisimopoulos","year":"2017","journal-title":"Healthc Technol Lett"},{"key":"2025081218220636500_ivaf180-B35","doi-asserted-by":"crossref","first-page":"3635","DOI":"10.1007\/s00464-018-06652-3","article-title":"Construct, content and face validity of the eoSim laparoscopic simulator on advanced suturing tasks","volume":"33","author":"Leijte","year":"2019","journal-title":"Surg Endosc"},{"key":"2025081218220636500_ivaf180-B36","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1080\/13645706.2019.1638411","article-title":"Construct validity of eoSim - a low-cost and portable laparoscopic simulator","volume":"29","author":"Mansoor","year":"2020","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"2025081218220636500_ivaf180-B37","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s11548-016-1459-3","article-title":"Objective assessment based on motion-related metrics and technical performance in laparoscopic suturing","volume":"12","author":"S\u00e1nchez-Margallo","year":"2017","journal-title":"Int J Comput Assist Radiol Surg"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivaf180\/63880997\/ivaf180.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/8\/ivaf180\/63880997\/ivaf180.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/8\/ivaf180\/63880997\/ivaf180.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T22:22:16Z","timestamp":1755037336000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf180\/8217276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":37,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8,5]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf180","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,7,29]]},"article-number":"ivaf180"}}