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Introduction: Musculoskeletal disorders are prevalent among surgical personnel due to static, awkward postures. While robotic-assisted transabdominal preperitoneal (rTAPP) repair is considered more ergonomic for surgeons than conventional laparoscopic TAPP (cTAPP), evidence on ergonomic differences for surgical assistants remains sparse. Assistants often maintain more constrained positions during surgery, potentially experiencing higher postural load. This study investigates ergonomic differences between rTAPP and cTAPP from the perspective of the surgical assistant.

Methods: This observational crossover study mirrors a previously published protocol on surgeons. Four experienced surgical assistants will participate, each assisting in two rTAPP and two cTAPP procedures. Surface electromyography (sEMG) will record muscle activity (erector spinae, trapezius, deltoids), and work posture will be captured using Xsens motion sensors. Perceived exertion will be measured using the Borg scale before and after each procedure. RULA scores derived from kinematic data will assess postural risk. Data will be analyzed using Wilcoxon rank-sum tests, with Bonferroni correction applied for multiple comparisons.

Results: Results from a corresponding surgeon-focused study showed that rTAPP was perceived as less physically demanding, with significantly lower post-operative Borg scores (median 1.5 vs. 3.0, p < 0.01). sEMG revealed significantly higher static activation in the left erector spinae (7.0% vs. 4.1% MVC) and median activation in the right trapezius (9.6% vs. 5.4% MVC) during rTAPP, however overall muscle activity patterns and median RULA posture scores were comparable between techniques. Given that assistants have more constrained and ergonomically unfavorable positions, we expect more pronounced differences in muscle activity and posture strain between rTAPP and cTAPP among assistants.

Discussion: If confirmed, our findings could support the use of robotic platforms to reduce ergonomic burden not only for surgeons but also for their assistants, a group often overlooked in ergonomic research. These insights may further advocate for ergonomic training and optimized operation room layouts that account for the entire surgical team.

Conclusion: This study aims to provide novel evidence on the ergonomic impact of surgical modality on assistants. We anticipate that rTAPP will offer significant ergonomic advantages over cTAPP for assistants, due to reduced physical strain and improved posture, highlighting the broader occupational benefits of robotic-assisted surgery.