Evidence map›Paper›PMID 40164838›Full record

Observational studySurgical endoscopy2025

Ergonomic strain of robotic-assisted versus laparoscopic inguinal hernia repair (ESRALI)-a crossover trial.

Alexandros Valorenzos, Kristian Als Nielsen, Per Helligsø, Michael Festersen Nielsen, Philip Wolfgang, Gert Frank Thomsen, Tina Dalager

Abstract readObservational StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Alexandros ValorenzosDepartment of General Surgery, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. alexandros.valsamidis.valorenzos@rsyd.dk.ORCID http://orcid.org/0000-0002-0249-3406
Kristian Als NielsenDepartment of General Surgery, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.
Per HelligsøDepartment of General Surgery, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.
Michael Festersen NielsenDepartment of General Surgery, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.
Philip WolfgangDepartment of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Gert Frank ThomsenDepartment of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Tina DalagerDepartment of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRobotic-assisted and laparoscopic techniques are widely used for inguinal hernia repair. While robotic-assisted transabdominal preperitoneal (rTAPP) repair is believed to offer ergonomic advantages for surgeons, there is limited evidence comparing its ergonomic impact to conventional laparoscopic TAPP (cTAPP) repair. This study aims to assess the ergonomic strain on surgeons during these procedures using subjective and objective measures.

methodsThis crossover observational study involved four experienced hernia surgeons who performed two procedures using each technique. Ergonomic strain was evaluated through self-reported perceived exertion (using the Borg scale), surface electromyography (sEMG) of select muscle groups, and posture analysis using rapid upper limb assessment (RULA) scores derived from kinematic data collected via Xsens Awinda. Statistical comparisons were conducted using the Wilcoxon rank-sum test, with adjustments for multiple comparisons.

resultsSubjectively, surgeons perceived rTAPP as less physically demanding, with lower postoperative perceived exertion scores (median 1.5 vs. 3.0, p < 0.01). Objective measurements showed higher static muscle activity in the left erector spinae and median activity in the right trapezius during rTAPP (p = 0.016), but overall ergonomic strain, as indicated by RULA scores, was similar across modalities. Median RULA scores for both techniques were 3, and no significant differences were observed in work posture scores. Despite these findings, discomfort during cTAPP was more frequently reported, with surgeons citing the neck, shoulders, and lower back as affected areas.

conclusionWhile rTAPP was subjectively perceived as less physically demanding, objective metrics did not corroborate these perceptions, showing comparable ergonomic strain between techniques. These findings highlight a complex relationship between subjective and objective ergonomic measures and suggest a need for further research, incorporating broader assessments of cognitive and physical loads, to optimize surgeon ergonomics in minimally invasive procedures.

Indexed as

ErgonomicsHernia, InguinalHerniorrhaphyLaparoscopyRobotic Surgical ProceduresAdultCross-Over StudiesElectromyographyFemaleHumansMaleMiddle AgedPostureSurgeonsErgonomicsInguinal hernia repairKinematic analysisLaparoscopyRobotic-assisted laparoscopySurface electromyography

Identifiers

PMID40164838
PMCPMC12041149

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.