Performance and adaptability comparison between medical students and experienced neurosurgeons using a robotic exoscope with a head-mounted display.

Integrating robotics in the operating room (OR) may revolutionize surgical practice by providing surgeons with enhanced precision, dexterity, and stability. Traditional operative microscopes often lead to significant musculoskeletal discomfort among surgeons due to prolonged, unergonomic postures. The advent of a robot-controlled exoscope (RS) offers a promising solution to these ergonomic challenges by enabling hands-free operation through head gestures. This study aimed to evaluate the usability and ergonomic benefits of the RS by comparing the performance of experienced neurosurgeons to that of students naive to microsurgery. In this study, we included neurosurgeons and medical students who navigated a custom-made parkour after a standardized 30-min training session. Metrics recorded included time to navigate each eyelet, number of commands executed, command errors, technical help required, and the accuracy of centering each eyelet. Post-exercise, participants completed a questionnaire assessing pain, visual quality, usability, and overall satisfaction. Neurosurgeons executed fewer commands (median 40, IQR 30.25-46) than students (median 44.5, IQR 38-57.5, p = 0.095). Time taken to navigate the parkour was similar across groups, but neurosurgeons showed greater efficiency from the third eyelet onward. Instances of automatic re-adjustments and reaching the RS physical limits were lower among neurosurgeons. Post-intervention questionnaires revealed no significant differences between groups in terms of comfort, visualization, image quality, depth perception, usability, and pain scores. The RS demonstrated potential ergonomic benefits and usability, with neurosurgeons showing improved efficiency compared to students. The lack of significant differences in post-intervention assessments suggests the RS is user-friendly for both experienced and novice users. These findings support the RS potential to enhance surgical ergonomics and reduce work-related musculoskeletal disorders, though further studies are needed to fully understand the learning curve and long-term benefits.