Surgeon and Assistant Workload in Laparoscopic Versus Robot-Assisted Surgery: Final Results From the ERGOROB Study

Background Ergonomic challenges in minimally invasive surgery may contribute to musculoskeletal disorders and reduced performance. Although surgeons’ workload has been studied, effects on assistants remain unclear. Aims To compare perceived workload among surgeons and assistants during robot-assisted versus laparoscopic surgery. Methods In this prospective, single-center study (May 2024–August 2025), procedures performed with both approaches were analyzed. Subjective workload was assessed postoperatively using a REDCap survey capturing the 6 NASA-Task Load Index dimensions and linked to clinical data from patient charts. Mixed-effects regression models evaluated associations between surgical approach, role (surgeon vs assistant), operative duration, and workload. A propensity score was estimated from surgical team and patient covariates and included as a single adjustment term. Results Of 234 eligible operations, 118 (59 laparoscopic; 59 robot-assisted) had complete team surveys, yielding 347 individual responses. Data were analyzed separately for surgeons and assistants. Surgeons (n=209) were predominantly male (73%) and older than assistants (n=138, mean 42 vs 29 years), who were mostly female (70%). Assistants reported more back pain than surgeons (25% vs 7%; p<0.0001). Workload differed by role and surgical access (interaction p=0.001). Surgeons reported lower physical demand (Δ -20, p<0.001), effort (Δ -5; p=0.05), and overall workload (Δ -5; p=0.05) in robot-assisted surgery. This reduction was confirmed in a propensity-score–adjusted model with a lower overall workload (Δ, -8.4; p=0.002). Among assistants, robot-assisted surgery was associated with higher mental (Δ +9.5; p=0.003) and temporal demand (Δ +13.4; p = 0.001) and a higher overall workload (Δ +7.1; p=0.012). However, after propensity-score adjustment, the higher overall workload was not statistically significant (Δ +5.4; p=0.09). Conclusion Robot-assisted surgery was associated with lower surgeon workload despite longer operative times, but assistant workload was not improved after adjustment. Identifying and addressing the factors that may limit ergonomic benefits for assistants could be valuable in supporting long-term team well-being.