Ergonomie in der Robotik – ein Leitfaden für die Praxis

Zusammenfassung

Die Ergonomie stellt in der Medizin, aber auch insbesondere in der robotischen Chirurgie weiterhin ein unterschätztes Thema dar. Trotz technischer Fortschritte leiden Chirurginnen und Chirurgen häufig unter muskuloskelettalen Beschwerden wie Nacken-, Rücken- und Handgelenksschmerzen. Vorherige Studien konnten zeigen, dass mangelndes Wissen über ergonomisches Arbeiten an der Konsole, unphysiologische Haltungen und fehlendes Training häufige Ursachen für Fehlhaltungen und assoziierte Beschwerden sind. Eine physiologische Körperhaltung stellt die Grundlage ergonomischen Arbeitens – sowohl im Stehen als auch im Sitzen dar. Besonderer Relevanz kommt hierbei einer neutralen Kopf-, Becken- und Wirbelsäulenstellung sowie der Rumpfstabilität und regelmäßigem Training der Haltemuskulatur zu.
Ein Vergleich verschiedener robotischer Systeme zeigt deutliche Unterschiede in der Konsolengestaltung und damit verbundene ergonomische Herausforderungen. Systeme mit flexibel einstellbarem Kopfteil verbessern z. B. die Nackenhaltung, während offene Konsolen die Kommunikation im OP-Saal unterstützen.
Auch die Rolle des Bedside Assistants ist aus ergonomischer Sicht kritisch. Die Diskrepanz zwischen motorischer und visueller Achse führt schnell zu Beschwerden im Nacken-, Schulter- und Armbereich. Strukturierte Ausbildungscurricula und ergonomische Trainings fehlen im chirurgischen Alltag.
Zur Prävention von muskuloskelettalen Beschwerden können gezielte Dehn- und Mobilisationsübungen während sog. Mikropausen durchgeführt werden, die nachweislich Schmerzen reduzieren und die Konzentration sowie die Leistung verbessern. Eine korrekte Einstellung der Konsole kann zudem den robotischen Arbeitsplatz signifikant ergonomisch verbessern.

Abstract

Ergonomics remain an underestimated challenge in medicine, particularly in robotic surgery. Despite technical advances, surgeons often suffer from musculoskeletal disorders often involving the neck, back, and wrist. Previous studies have shown that a lack of knowledge and awareness of ergonomic recommendations for the use of the console, unnatural or poor physiological postures, and a lack of training are common causes of poor posture and associated complaints. A physiological posture is the basis for a healthy workspace, both when standing and sitting. Of particular relevance are a neutral head, pelvis, and spine position, as well as core stability and regular training of the critical muscles for a stable posture.
A comparison of different robotic systems revealed significant differences in console design and associated ergonomic challenges. Systems with adjustable headpieces, for example, improve neck posture, while open consoles facilitate communication in the operating room.
In addition, the role of the bedside assistant is critical from an ergonomic perspective. The discrepancy between the motor and visual axes quickly leads to discomfort in the neck, shoulder, and arm areas. Structured training curricula and ergonomic guidelines are lacking in everyday surgical practice.
To prevent musculoskeletal pain and potential disorders, targeted stretching and mobilization exercises can be performed during so-called micro breaks, which have been proven to reduce pain and improve concentration and performance. Correct adjustment of the console can also significantly improve the ergonomics in the robotic operating theatre.

Schlüsselwörter

Robotik - Ergonomie - Körperhaltung - robotische Chirurgie

Keywords

robotics - ergonomics - posture - robotic surgery

Publication History

Received: 14 October 2025

Accepted after revision: 08 December 2025

Article published online:
23 January 2026

• Literatur

• 1 International Ergonomics & Human Factors, Association. What Is Ergonomics (HFE)?. Accessed October 03, 2025 at: https://iea.cc/about/what-is-ergonomics/
• 2 Catanzarite T, Tan-Kim J, Whitcomb EL. et al. Ergonomics in Surgery: A Review. Female Pelvic Med Reconstr Surg 2018; 24: 1-12
• 3 Krauss DT, Brunner S, Eckhoff JA. et al. Evaluation of posture in four different robotic surgical systems. Surg Endosc 2025; 39: 7649-7657
• 4 Wauben LS, van Veelen MA, Gossot D. et al. Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc 2006; 20: 1268-1274
• 5 Franasiak J, Craven R, Mosaly P. et al. Feasibility and acceptance of a robotic surgery ergonomic training program. JSLS 2014; 18: e2014.00166
• 6 Wells AC, Kjellman M, Harper SJF. et al. Operating hurts: a study of EAES surgeons. Surg Endosc 2019; 33: 933-940
• 7 Galleano R, Carter F, Brown S. et al. Can armrests improve comfort and task performance in laparoscopic surgery?. Ann Surg 2006; 243: 329-333
• 8 Xiao D, Jakimowicz J, Albayrak A. et al. Ergonomic factors on task performance in laparoscopic surgery training. Appl Ergon 2012; 43: 548-553
• 9 Smedley J, Trevelyan F, Inskip H. et al. Impact of ergonomic intervention on back pain among nurses. Scand J Work Environ Health 2003; 29: 117-123
• 10 Park RM, Bushnell PT, Bailer AJ. et al. Impact of publicly sponsored interventions on musculoskeletal injury claims in nursing homes. Am J Ind Med 2009; 52: 683-697
• 11 Evanoff BA, Bohr PC, Wolf LD. Effects of a participatory ergonomics team among hospital orderlies. Am J Ind Med 1999; 35: 358-365
• 12 Nelson A, Matz M, Chen F. et al. Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. Int J Nurs Stud 2006; 43: 717-733
• 13 OECD, European Commission. Health at a Glance: Europe 2024: State of Health in the EU Cycle. Paris: OECD Publishing; 2024.
• 14 American Academy of Orthopaedic Surgeons (AAOS). Posture and Its Relationship to Orthopaedic Disabilities—A Report of the Posture Committee. Evanston, IL, USA: American Academy of Orthopaedic Surgeons; 1947
• 15 Lux MM, Marshall M, Erturk E. et al. Ergonomic evaluation and guidelines for use of the daVinci Robot system. J Endourol 2010; 24: 371-375
• 16 Lawson EH, Curet MJ, Sanchez BR. et al. Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project. J Robot Surg 2007; 1: 61-67
• 17 Peterson Kendall F, Kendall McCreary E, Geise Provance P. et al. Muskeln: Funktionen und Tests. München: Elsevier, Urban & Fischer; 2009
• 18 Wahba R, Datta R, Bußhoff J. et al. 3D Versus 4 K Display System – Influence of “State-of-the-art”-Display Technique on Surgical Performance (IDOSP-study) in Minimally Invasive Surgery: A Randomized Cross-over Trial. Ann Surg 2020; 272: 709-714
• 19 Gietzelt C, Datta R, Busshoff J. et al. The influence of stereoscopic vision on surgical performance in minimal invasive surgery—a substudy of the IDOSP-Study (Influence of 3D- vs. 4 K-Display Systems on Surgical Performance in minimal invasive surgery). Langenbecks Arch Surg 2022; 407: 3069-3078
• 20 Meltzer AJ, Hallbeck MS, Morrow MM. et al. Measuring Ergonomic Risk in Operating Surgeons by Using Wearable Technology. JAMA Surg 2020; 155: 444-446
• 21 Jones R, Credeur DP, McCoy SM. Occupational sitting and work engagement among university employees. J Am Coll Health 2023; 71: 600-606
• 22 Grasser T, Borges Dario A, Carmo Silva Parreira P. et al. Defining text neck: a scoping review. Eur Spine J 2023; 32: 3463-3484
• 23 Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int 2014; 25: 277-279
• 24 Brunner S, Müller D, Krauss DT. et al. Cologne ergonomic measurement for robotic surgery (CEMRobSurg) using the HugoTM RAS System. Surg Endosc 2024; 38: 6128-6138
• 25 Intuitive. Meet the da Vinci 5 robotic surgical system. Accessed October 03, 2025 at: https://www.intuitive.com/en-us/products-and-services/da-vinci/5
• 26 Onol FF, Sivaraman A, Andrich J. The Role of Bedside Assistant in Robotic Urological Surgery. In: Robotic Urologic Surgery. 3. 2022: 39-49
• 27 Garbens A, Lay AH, Steinberg RL. et al. Experienced bedside-assistants improve operative outcomes for surgeons early in their learning curve for robot assisted laparoscopic radical prostatectomy. J Robot Surg 2021; 15: 619-626
• 28 Zeuschner P, Meyer I, Siemer S. et al. Three Different Learning Curves Have an Independent Impact on Perioperative Outcomes After Robotic Partial Nephrectomy: A Comparative Analysis. Ann Surg Oncol 2021; 28: 1254-1261
• 29 Brian R, Murillo A, Gomes C. et al. Consensus guidelines on the bedside assistant skills required in robotic surgery. Surg Endosc 2024; 38: 6406-6412
• 30 Wong SW, Ang ZH, Crowe P. Improving ergonomics for the bedside assistant in robotic colorectal surgery. J Surg Case Rep 2023; 2023: rjad007
• 31 Wong SW, Crowe P. Visualisation ergonomics and robotic surgery. J Robot Surg 2023; 17: 1873-1878
• 32 Matern U, Faist M, Kehl K. et al. Monitor position in laparoscopic surgery. Surg Endosc 2005; 19: 436-440
• 33 Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl 1989; 230: 1-54
• 34 Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med 2006; 36: 189-198
• 35 Albrecht K. Körperhaltung. Modernes Rückentraining. 4. Stuttgart: Thieme; 2018.
• 36 Comerford MJ, Mottram SL. Movement and stability dysfunction – contemporary developments. Man Ther 2001; 6: 15-26
• 37 Park AE, Zahiri HR, Hallbeck MS. et al. Intraoperative “Micro Breaks” With Targeted Stretching Enhance Surgeon Physical Function and Mental Focus: A Multicenter Cohort Study. Ann Surg 2017; 265: 340-346
• 38 Santos-Carreras L, Hagen M, Gassert R. et al. Survey on surgical instrument handle design: ergonomics and acceptance. Surg Innov 2012; 19: 50-59