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Objectives and questions: This prospective, multicentre European evaluation investigated the impact of handheld robotic-assisted (RA) technology on operating room (OR) staff wellbeing during revision total knee arthroplasty (rTKA). The primary objective was to determine whether the use of the CORI™ Surgical System (Smith & Nephew, USA) reduced perceived intraoperative workload compared with conventional manual instrumentation. The NASA Task Load Index (NASA-TLX) was used to quantify workload across six domains (Mental, Physical, Temporal demand, Performance, Effort, and Frustration) to generate an Overall Workload Score (OWS; −50 best to +50 worst). Recognising the growing adoption of robotic systems across Europe, this project also explored early national trends, including site-specific data from Germany.

Material and methods: NASA-TLX surveys were completed by a range of OR personnel (lead surgeons, surgical trainees, scrub nurses, and circulating nurses) after rTKA procedures performed using either handheld RA or manual instrumentation across seven European countries, including Germany. The inclusion of diverse roles provides a holistic view of intraoperative workload dynamics beyond the surgeon alone. In total, 334 complete surveys were included in the analysis (manual n=137; RA n=197). To better understand local variability, early data from Germany were also evaluated separately (manual n=19; RA n=16).

Results: The overall findings demonstrated a significant reduction in perceived workload with RA compared with manual instrumentation (median OWS 0.0 vs 9.0, p<0.0001). Across domains, mental and physical demands as well as effort were all significantly lower in the RA group, while other domains (temporal demand, performance, and frustration) showed no negative impact, indicating that robotic support reduced strain without compromising workflow or perceived surgical quality. Subgroup analysis focusing on lead surgeons confirmed these trends, suggesting consistent benefits across all experience levels. The early German results showed a notably larger effect size, with the median OWS improving from 13.0 with manual instruments to −18.5 using RA technology.

Discussion and conclusions: This real-world evaluation provides robust evidence that handheld RA systems can meaningfully reduce intraoperative workload for OR staff during rTKA. Specifically, the RA system was associated with lower perceived physical and mental demands without compromising performance. Findings from Germany particularly emphasise the local relevance of RA technology as a strategy to improve workforce wellbeing and mitigate physical strain. As healthcare systems across Europe seek to implement sustainable surgical innovations, these multicentre data support the integration of handheld RA systems as a valuable adjunct to modern rTKA workflows