Human factors and team safety in robotic-assisted surgery: a narrative review of ergonomic risks and educational implications.

BACKGROUND

Robot-assisted surgery (RAS) has revolutionized minimally invasive surgery through enhanced dexterity, precision, and three-dimensional visualization. However, as surgeons become physically separated from the operative field, new risks emerge, including staff injuries, arm collisions, communication failures, and diminished situational awareness. This review aimed to synthesize current evidence on ergonomic, cognitive, and non-technical factors influencing staff safety in RAS.

METHODS

A narrative review synthesized English-language studies published until 2025 on staff safety, arm interference, and non-technical skills (NTS) in RAS. Literature was searched in PubMed, Scopus, and Embase using terms such as robotic surgery, bedside assistant, arm collision, injury, workflow disruption, human factors, and NTS. Eligible publications included case reports, observational studies, ergonomic analyses, and educational frameworks. Data were grouped into four domains: (1) ergonomic and cognitive challenges, (2) staff injuries and near-misses, (3) NTS deficits, and (4) educational countermeasures.

RESULTS

RAS introduces ergonomic and cognitive stressors (restricted workspaces, multiple arms, limited visibility, and loss of tactile feedback), causing injuries such as hand entrapment and arm collisions. FDA MAUDE registry reported over 1,300 injuries and 8,000 device malfunctions, approximately 10% involving staff. Cognitive analyses showed console surgeons' visual immersion reduced team awareness and coordination. Curricula focus on console skills but underemphasize NTS. Interventions such as dual-console mentoring, simulation-based teamwork, and structured NTS coaching improved awareness and reduced workload stress.

CONCLUSIONS

RAS enhances precision but introduces human-factor risks. Sustainable safety requires integrating ergonomics, NTS, and communication into robotic training through simulation, feedback, and reflection-ensuring innovation supports both performance and humanity.