{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T22:41:34Z","timestamp":1781908894712,"version":"3.54.5"},"reference-count":38,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Regional Government of Extremadura, the Spanish Ministry of Science, Innovation and Universities, the European Social Fund, the European Regional Development Fund and European Union NextGenerationEU funds","award":["PD18077"],"award-info":[{"award-number":["PD18077"]}]},{"name":"Regional Government of Extremadura, the Spanish Ministry of Science, Innovation and Universities, the European Social Fund, the European Regional Development Fund and European Union NextGenerationEU funds","award":["TA18023"],"award-info":[{"award-number":["TA18023"]}]},{"name":"Regional Government of Extremadura, the Spanish Ministry of Science, Innovation and Universities, the European Social Fund, the European Regional Development Fund and European Union NextGenerationEU funds","award":["GR21201"],"award-info":[{"award-number":["GR21201"]}]},{"name":"Regional Government of Extremadura, the Spanish Ministry of Science, Innovation and Universities, the European Social Fund, the European Regional Development Fund and European Union NextGenerationEU funds","award":["PRTR-C17.I1"],"award-info":[{"award-number":["PRTR-C17.I1"]}]},{"name":"Regional Government of Extremadura, the Spanish Ministry of Science, Innovation and Universities, the European Social Fund, the European Regional Development Fund and European Union NextGenerationEU funds","award":["2021\u20132027"],"award-info":[{"award-number":["2021\u20132027"]}]},{"name":"Recovery, Transformation and Resilience Plan","award":["PD18077"],"award-info":[{"award-number":["PD18077"]}]},{"name":"Recovery, Transformation and Resilience Plan","award":["TA18023"],"award-info":[{"award-number":["TA18023"]}]},{"name":"Recovery, Transformation and Resilience Plan","award":["GR21201"],"award-info":[{"award-number":["GR21201"]}]},{"name":"Recovery, Transformation and Resilience Plan","award":["PRTR-C17.I1"],"award-info":[{"award-number":["PRTR-C17.I1"]}]},{"name":"Recovery, Transformation and Resilience Plan","award":["2021\u20132027"],"award-info":[{"award-number":["2021\u20132027"]}]},{"name":"Extremadura ERDF Operational Program","award":["PD18077"],"award-info":[{"award-number":["PD18077"]}]},{"name":"Extremadura ERDF Operational Program","award":["TA18023"],"award-info":[{"award-number":["TA18023"]}]},{"name":"Extremadura ERDF Operational Program","award":["GR21201"],"award-info":[{"award-number":["GR21201"]}]},{"name":"Extremadura ERDF Operational Program","award":["PRTR-C17.I1"],"award-info":[{"award-number":["PRTR-C17.I1"]}]},{"name":"Extremadura ERDF Operational Program","award":["2021\u20132027"],"award-info":[{"award-number":["2021\u20132027"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>BACKGROUND: This study aims to implement a set of wearable technologies to record and analyze the surgeon\u2019s physiological and ergonomic parameters during the performance of conventional and robotic-assisted laparoscopic surgery, comparing the ergonomics and stress levels of surgeons during surgical procedures. METHODS: This study was organized in two different settings: simulator tasks and experimental model surgical procedures. The participating surgeons performed the tasks and surgical procedures in both laparoscopic and robotic-assisted surgery in a randomized fashion. Different wearable technologies were used to record the surgeons\u2019 posture, muscle activity, electrodermal activity and electrocardiography signal during the surgical practice. RESULTS: The simulator study involved six surgeons: three experienced (&gt;100 laparoscopic procedures performed; 36.33 \u00b1 13.65 years old) and three novices (&lt;100 laparoscopic procedures; 29.33 \u00b1 8.39 years old). Three surgeons of different surgical specialties with experience in laparoscopic surgery (&gt;100 laparoscopic procedures performed; 37.00 \u00b1 5.29 years old), but without experience in surgical robotics, participated in the experimental model study. The participating surgeons showed an increased level of stress during the robotic-assisted surgical procedures. Overall, improved surgeon posture was obtained during robotic-assisted surgery, with a reduction in localized muscle fatigue. CONCLUSIONS: A set of wearable technologies was implemented to measure and analyze surgeon physiological and ergonomic parameters. Robotic-assisted procedures showed better ergonomic outcomes for the surgeon compared to conventional laparoscopic surgery. Ergonomic analysis allows us to optimize surgeon performance and improve surgical training.<\/jats:p>","DOI":"10.3390\/s24123840","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T03:52:53Z","timestamp":1718337173000},"page":"3840","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Comparative Study of Ergonomics in Conventional and Robotic-Assisted Laparoscopic Surgery"],"prefix":"10.3390","volume":"24","author":[{"given":"Manuel J.","family":"P\u00e9rez-Salazar","sequence":"first","affiliation":[{"name":"Bioengineering and Health Technologies Unit, Jes\u00fas Us\u00f3n Minimally Invasive Surgery Centre, ES-10004 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Caballero","sequence":"additional","affiliation":[{"name":"Bioengineering and Health Technologies Unit, Jes\u00fas Us\u00f3n Minimally Invasive Surgery Centre, ES-10004 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0100-2695","authenticated-orcid":false,"given":"Juan A.","family":"S\u00e1nchez-Margallo","sequence":"additional","affiliation":[{"name":"Bioengineering and Health Technologies Unit, Jes\u00fas Us\u00f3n Minimally Invasive Surgery Centre, ES-10004 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2138-988X","authenticated-orcid":false,"given":"Francisco M.","family":"S\u00e1nchez-Margallo","sequence":"additional","affiliation":[{"name":"Scientific Direction, Jes\u00fas Us\u00f3n Minimally Invasive Surgery Centre, ES-10004 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1038\/s41585-020-00414-4","article-title":"Surgical ergonomics for urologists: A practical guide","volume":"18","author":"Gabrielson","year":"2021","journal-title":"Nat. Rev. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4103\/ijawhs.IJAWHS_52_22","article-title":"Ergonomics in robot-assisted surgery in comparison to open or conventional laparoendoscopic surgery: A narrative review","volume":"6","author":"Ahn","year":"2023","journal-title":"Int. J. Abdom. Wall Hernia Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/bjs5.104","article-title":"Acute mental stress and surgical performance: Acute mental stress and surgical performance","volume":"3","author":"Grantcharov","year":"2019","journal-title":"BJS Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1007\/s00268-011-1141-4","article-title":"Development and validation of a surgical workload measure: The surgery task load index (SURG-TLX)","volume":"35","author":"Wilson","year":"2011","journal-title":"World J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Nillahoot, N., Pillai, B.M., Sharma, B., Wilasrusmee, C., and Suthakorn, J. (2022). 3D Force\/Torque parameter acquisition and correlation identification during primary trocar insertion in laparoscopic abdominal surgery: 5 cases. Sensors, 22.","DOI":"10.3390\/s22228970"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1007\/s00464-018-6515-3","article-title":"Ergonomics of minimally invasive surgery: An analysis of muscle effort and fatigue in the operating room between laparoscopic and robotic surgery","volume":"33","author":"Armijo","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Merbah, J., Car\u00e9, B.R., Gorce, P., Gadea, F., and Prince, F. (2023). A new approach to quantifying muscular fatigue using wearable EMG sensors during surgery: An ergonomic case study. Sensors, 23.","DOI":"10.3390\/s23031686"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Guzm\u00e1n-Garc\u00eda, C., S\u00e1nchez-Gonz\u00e1lez, P., S\u00e1nchez-Margallo, J.A., Snoriguzzi, N., Rabazo, J.C., S\u00e1nchez-Margallo, F.M., G\u00f3mez, E.J., and Oropesa, I. (2022). Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics. Sensors, 22.","DOI":"10.3390\/s22030837"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Takacs, K., Lukacs, E., Levendovics, R., Pekli, D., Szjiarto, A., and Haidegger, T. (2024). Assessment of surgeons\u2019 stress levels with digital sensors during robot-assisted surgery: An experimental study. Sensors, 24.","DOI":"10.3390\/s24092915"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S1050-6411(00)00027-4","article-title":"Development of recommendations for SEMG sensors and sensor placement procedures","volume":"10","author":"Hermens","year":"2000","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"551","DOI":"10.3233\/WOR-210239","article-title":"Application of the rapid upper limb assessment tool to assess the level of ergonomic risk among health care professionals: A systematic review","volume":"71","author":"Kakaraparthi","year":"2022","journal-title":"Work"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1080\/00140139.2015.1023851","article-title":"Influences on the use of observational methods by practitioners when identifying risk factors in physical work","volume":"58","year":"2015","journal-title":"Ergonomics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.apergo.2013.12.001","article-title":"Using Kinect sensor in observational methods for assessing postures at work","volume":"45","year":"2014","journal-title":"Appl. Ergon."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.medengphy.2020.01.017","article-title":"New joint analysis of electromyography spectrum and amplitude-based methods towards real-time muscular fatigue evaluation during a simulated surgical procedure: A pilot analysis on the statistical significance","volume":"79","author":"Dufaug","year":"2020","journal-title":"Med. Eng. Phys."},{"key":"ref_15","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":"ref_16","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s11701-024-01853-6","article-title":"The stress for surgeons: Exploring stress entities with the robotic senhance surgical system","volume":"18","author":"Menke","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s11701-024-01834-9","article-title":"Examining surgeon stress in robotic and laparoscopic surgery","volume":"18","author":"Sujka","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1177\/1553350618759768","article-title":"Assessment of Postural Ergonomics and Surgical Performance in Laparoendoscopic Single-Site Surgery Using a Handheld Robotic Device","volume":"25","year":"2018","journal-title":"Surg. Innov."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s11701-019-00996-1","article-title":"Ergonomic assessment of robotic general surgeons: A pilot study","volume":"14","author":"Dwyer","year":"2020","journal-title":"J. Robot. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1007\/s00464-010-1512-1","article-title":"Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favoured by more surgeons compared with laparoscopy","volume":"25","author":"Stefanidis","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gianikellis, K., Skiadopoulos, A., Palma, C.E., Sanchez-Margallo, F.M., Carrasco, J.B.P., and Sanchez-Margallo, J.A. (2014, January 12\u201315). A method to assess upper-body postural variability in laparoscopic surgery. Proceedings of the 5th IEEE RAS\/EMBS International Conference on Biomedical Robotics and Biomechatronics, Sao Paulo, Brazil.","DOI":"10.1109\/BIOROB.2014.6913755"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s00464-016-5047-y","article-title":"Intraoperative workload in robotic surgery assessed by wearable motion tracking sensors and questionnaires","volume":"31","author":"Yu","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s11701-012-0374-z","article-title":"A comparison of surgeon\u2019s postural muscle activity during robotic-assisted and laparoscopic rectal surgery","volume":"7","author":"Szeto","year":"2013","journal-title":"J. Robot. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1097\/SLA.0000000000002845","article-title":"Robotic Surgery Is Less Physically Demanding Than Laparoscopic Surgery: Paired Cross Sectional Study","volume":"271","author":"Dalsgaard","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1002\/bjs.11394","article-title":"Surgeons\u2019 posture and muscle strain during laparoscopic and robotic surgery","volume":"107","author":"Dalager","year":"2020","journal-title":"Br. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1007\/s00464-016-5076-6","article-title":"Comparison of fatigue accumulated during and after prolonged robotic and laparoscopic surgical methods: A cross-sectional study","volume":"31","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1007\/s11701-023-01608-9","article-title":"Muscle fatigue and physical discomfort reported by surgeons performing robotic-assisted surgery: A multinational survey","volume":"17","author":"Patel","year":"2023","journal-title":"J. Robot. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1080\/00140138708966046","article-title":"A worksite method for shoulder muscle fatigue measurement using EMG, test contractions and zero crossing technique","volume":"30","author":"Liew","year":"1987","journal-title":"Ergonomics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.nmd.2012.10.003","article-title":"The relationship between muscle pain and fatigue","volume":"22","author":"Mastaglia","year":"2012","journal-title":"Neuromuscul. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/S0169-8141(99)00053-0","article-title":"Electromyographical indication of muscular fatigue in occupational field studies","volume":"25","author":"Luttmann","year":"2000","journal-title":"Int. J. Ind. Ergon."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1007\/s00420-018-1344-1","article-title":"An ergonomic field study to evaluate the effects of a rotatable handle piece on muscular stress and fatigue as well as subjective ratings of usability, wrist posture and precision during laparoscopic surgery: An explorative pilot study","volume":"91","author":"Seibt","year":"2018","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.apergo.2016.01.010","article-title":"Exposure-response relationship for work-related neck and shoulder musculoskeletal disorders\u2014Analyses of polled uniform data sets","volume":"55","author":"Nordander","year":"2016","journal-title":"Appl. Ergon."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5975","DOI":"10.1007\/s00464-023-10042-9","article-title":"Intraoperative active and passive break during minimally invasive surgery influence upper extremity physical strain and physical stress response\u2014A controlled, randomized cross-over, laboratory trial","volume":"37","author":"Luger","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1080\/00140130903039101","article-title":"Increased physical workloads in modern work\u2014A necessity for better health and performance?","volume":"52","author":"Straker","year":"2009","journal-title":"Ergonomics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e2113","DOI":"10.1002\/rcs.2113","article-title":"A systematic review of the true benefit of robotic surgery: Ergonomic","volume":"16","author":"Wee","year":"2020","journal-title":"Int. J. Med. Robot. Comput. Assist. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s004210000285","article-title":"The role of muscle activity and mental load in the development of pain and degenerative processes at the muscle cell level during computer work","volume":"83","author":"Sjogaard","year":"2000","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1007\/s00464-013-3334-4","article-title":"Objective analysis of surgeons\u2019 ergonomy during laparoendoscopic single-site surgery through the use of surface electromyography and a motion capture data glove","volume":"28","year":"2014","journal-title":"Surg. Endosc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.jelekin.2006.03.004","article-title":"The effect of handedness on electromyograpic activity of human shoulder muscle during movement","volume":"17","author":"Diederichsen","year":"2007","journal-title":"J. Electromyogr. Kinesiol."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/12\/3840\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:58:24Z","timestamp":1760108304000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/12\/3840"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,14]]},"references-count":38,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["s24123840"],"URL":"https:\/\/doi.org\/10.3390\/s24123840","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,14]]}}}