Manipulation ergonomics and robotic surgery-a narrative review

Background and Objective: The robotic system offers manipulation ergonomic advantages through articulated instruments with seven degrees of freedom (DOF), fulcrum elimination, filtration of tremor, and scaling of movement. The objective of this narrative review is to address the manipulation ergonomic considerations of robotic surgery. Methods: A literature review was performed to find evidence for the postulated manipulation advantages and disadvantages. Key Content and Findings: An increase in DOF from four to six has been shown to reduce task completion time by 40%. The detrimental effect of the fulcrum effect (including the associated scaling of movement) on performance of a laparoscopic task has been demonstrated for novice surgeons. Tremor filtration alone may not improve accuracy during robotic tasks. Scaling of movement can increase accuracy by 20-30%. Conferring of ambidexterity improves the accuracy of the non-dominant hand. Control of camera and three instruments, and use of intuitive hand controllers and foot pedals can improve efficiency. Surgeons should be conscious of the fact that different robotic instruments have different grip forces. Lack of haptic feedback and robot arm clashes are manipulation disadvantages that need to be overcome. Conclusions: Advanced technology has been used to support manipulation in robotic-assisted surgery. The integrated technologies of flexible instrument tips with seven DOF, scaling effect, removal of the fulcrum effect, and control of more instruments offer ergonomic benefits to the surgeon. On the other hand, limitations related to lack of haptic feedback and arm clashing need to be overcome to improve the surgeon experience.