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Common symptoms include neck, back, and shoulder pain, as well as generalized fatigue, particularly among those performing laparoscopic and robotic procedures. Key risk factors include static posture, repetitive motion, and prolonged procedural duration. Female surgeons also were cited to face elevated MSD risk due to equipment design mismatches and physiological factors, while residents report higher pain levels than attendings, often linked to workload and limited ergonomic training. The surgical environment plays a critical role in MSD development. Poor ergonomics in the operating room include issues such as suboptimal table height and instrument design, which exacerbate physical strain. Although robotic surgery improves posture, it does not eliminate discomfort, and endoscopic approaches impose unique demands. Mitigation strategies include ergonomic training, optimized posture and table height, redesigned instruments, and supportive hardware such as ergonomic chairs. Behavioral interventions such as microbreaks, ambidexterity training, and stretching have shown promise in enhancing endurance and reducing fatigue. Importantly, for surgeons, MSDs contribute to early retirement, burnout, and workforce shortages. This paper advocates for a paradigm shift: viewing surgeon fatigue not as a personal failure but because of system design. 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