Ergonomic Considerations in Robotic-assisted Microsurgery.

[OBJECTIVE] Microsurgery necessitates precision and skill, with conventional methods often leading to surgeon discomfort due to prolonged static postures. The introduction of robot-assisted microsurgery using the Symani surgical system and a three-dimensional exoscope aims to enhance surgical precision while mitigating these ergonomic issues.

[METHODS] This prospective, single-center clinical study involved 50 preclinical training sessions and 87 robot-assisted microsurgical procedures at the authors' institution, covering a wide array of interventions from free flap reconstructions to nerve and lymphatic surgeries. Ergonomic assessment was conducted using the Localized Experienced Discomfort (LED) questionnaire, completed post-procedure. The study adhered to the Helsinki Declaration and received local ethics committee approval.

[RESULTS] The neck and back region experienced the most discomfort ( P < 0.0001). Notably, operations performed with an exoscope showed significantly lower discomfort scores, particularly in the occipital and neck regions, compared with those using traditional microscopes ( P < 0.05). Preclinical and clinical LED scores did not show a significant difference ( P < 0.05). Using a Pearson correlation analysis, a correlation between LED scores and operating time was found.

[CONCLUSION] The authors' study's findings, in conjunction with existing literature, herald a promising shift towards more ergonomic microsurgical practices through the use of robotic assistance and three-dimensional mesoscopic systems. Continued research and innovation in this direction are not only anticipated but necessary for the evolution of microsurgical techniques and the well-being of surgeons in the field.