Critical analysis on the assessment of ergonomics in robotic surgery: A scoping review.

Ergonomics has long been cited as one of the principal advantages of robotic surgery, yet nearly three decades of research have yielded heterogeneous, inconsistent, and often contradictory findings. A coherent understanding of how ergonomic metrics have been conceptualized, operationalized, and measured remains lacking. This scoping review critically examines the tools, variables, and methodological approaches used to assess ergonomics in robotic surgery and identifies structural limitations that may impede scientific progress in the field. Following PRISMA-ScR guidelines, we searched PubMed and Scopus for studies explicitly evaluating ergonomic outcomes in robotic surgery (March 1997–September 2025), supplemented by citation mining. Data were extracted regarding measurement tools, variables, study design, and anatomical or conceptual domains. A total of 119 studies met inclusion criteria, reporting 42 measurement tools and 97 variables assessed 328 times. Fewer than 10% of variables accounted for half of all measurements, and 50% of tools were used only once. No tool was originally designed for robotic surgery ergonomics, and nearly all available evidence centers on the da Vinci platform, generating a structural bias that limits generalizability. Ergonomic research in robotic surgery is characterized by conceptual inconsistency, methodological fragility, and platform-dependent evidence. Standardized terminology, validated instruments, and multi-platform evaluation frameworks are urgently needed as new robotic systems enter the clinical landscape.