Ergonomic impact of closed-console (Da Vinci Xi) versus open-console (Hugo RAS) robotic systems: an ex vivo randomized crossover controlled trial.

BACKGROUND

Robotic technology, based on either open- or closed-console systems, has improved precision, visualization, and ergonomics for surgeons. However, its effects on surgeons' visual health and ocular function have not been studied.

METHODS

A randomized crossover trial was conducted among 20 stereo-enabled surgery residents. They were randomly allocated into closed-console (DaVinci Surgical system) or open-console (HugoTMRAS) groups. Participants did identical simulated tasks for 90 min. Visual strain was assessed subjectively using visual fatigue questionnaire and objectively through near point of accommodation (NPA) and near point of convergence (NPC) using RAF ruler test, stereoacuity using Netherlands Organisation for Applied Scientific Research (TNO) stereopsis test, tear production using Schirmer's test, and tear film stability using Tear Break-Up Time (TBUT). Musculoskeletal strain was measured using SAGES body discomfort and NORDIC musculoskeletal questionnaire (NMSQ).

RESULTS

Both groups had comparable demographics and ophthalmic parameters at baseline. After simulated task, open-console group had significant worsening in tearing (p = 0.042), while close console group had significant deterioration in neck stiffness (p=0.018), neck discomfort (p = 0.046), and upper back discomfort (p = 0.019). Within-platform analysis showed post-task increase in pressure around eyes (p = 0.011), dry eyes (p = 0.008), heaviness of eyelids (p = 0.007), headache (p = 0.025), eye pain (p = 0.024), worsened NPC (p = 0.014), and declined TBUT (right: p = 0.044; left: p = 0.022) in open console. Closed-console group had increased pressure around eyes (p = 0.015), dry eyes (p = 0.013), heaviness of eyelids (p = 0.042); worsened NPC (p = 0.009), and declined left-eye TBUT (p = 0.010).

CONCLUSION

Both robotic systems have negative ocular impact, although more with open console. Musculoskeletal discomfort was more on closed console. These findings emphasize the need for ocular and ergonomic training and console design improvements.