# Ergonomic evaluation of the Senhance® robotic system in minimally invasive gynecologic procedures versus conventional laparoscopy: an exploratory study focusing on surgeon’s muscle activity

## TL;DR

This study explores whether the Senhance® robotic system reduces physical strain on surgeons during gynecologic procedures compared to traditional laparoscopy.

## Contribution

The study introduces an ergonomic evaluation of the Senhance® robotic system with a focus on muscle activity and eye-tracking features in surgery.

## Key findings

- Four out of seven muscles showed reduced activation with Senhance®, except the left shoulder–neck area.
- No musculoskeletal discomfort or eyestrain was reported under either surgical condition.
- Working precision was subjectively higher during standard laparoscopy.

## Abstract

Primary: To evaluate whether robotic-assisted laparoscopic surgery using the Senhance® Surgical System has the potential to reduce muscular demands compared to conventional laparoscopy. Secondary: To verify that the novel eye-tracking feature for zoom and the selection of functions in the Senhance® System menu is not associated with increased eyestrain or neck strain.

In a within-subject design, 2 experienced surgeons performed 11 robot-assisted and 12 conventional laparoscopic procedures. Muscular demands were monitored throughout surgical procedures by assessing the muscle activity via bipolar surface electromyography of seven muscles of the lower back, shoulder–neck, and forearms. Surgeons’ head, arm, and torso posture was assessed by gravimetrical position sensors. Furthermore, musculoskeletal discomfort, mental and physical workload, task difficulty and working precision were rated by the surgeons. In addition, a ten-item eyestrain questionnaire was administered after each surgical procedure.

Four out of seven muscles were relieved when working with Senhance®. Only in the left shoulder–neck area there was a statistically significant increase in muscle activation associated with robotic-assisted surgery. Changes in surgeons’ posture related to the surgical technique corresponded to the changes in muscle activation. Furthermore, surgeons reported no musculoskeletal discomfort under both conditions and similar levels of workload (mental and physical), and task difficulty. Working precision was subjectively rated to be better during standard laparoscopy. No eyestrain occurred during any of the procedures.

This exploratory study identified the potential of the Senhance® Surgical System for ergonomic improvements and indicated no impairments by the novel eye-tracking feature on muscle demands and eyestrain. Follow-up studies with larger and more diverse indications are needed that also consider clinical outcomes, which were not part of the present study.

The online version contains supplementary material available at 10.1007/s00404-025-08292-0.