A Comparative Study of the Ergonomic Risk to the Surgeon During Vesicoscopic and Robotic Cross-Trigonal Ureteric Reimplantation.

Background: Maintenance of the body posture and precise repetitive movements during minimally invasive surgeries predispose the surgeons to the risk of musculoskeletal disorders (MSDs). The present study was designed to estimate the ergonomic risk of MSDs in a single surgeon while performing vesicoscopic ureteric reimplantation. Materials and Methods: All children with primary vesicoureteric reflux (VUR) undergoing vesicoscopic ureteric reimplantation through the laparoscopic (Group 1) or robotic (Group 2) approaches from July 2015 to October 2019 were included. Data, including age at the time of surgery, gender, the severity of VUR (grade), number of ureters involved (unilateral or bilateral), and procedural details, were recorded. Rapid Entire Body Assessment (REBA) tool was used for the ergonomic risk assessment of each procedure. The REBA scores were graded as negligible (1), low (2-3), medium (4-7), high (8-10), and very high (11 or more). The risk index was considered as normal (1 or less) and high (>1). The ergonomic risk associated with both approaches was compared. Results: A total of 16 patients (Male:Female = 9:7) were included in the present study. Groups 1 and 2 had 11 and 5 patients, respectively. The average (range) age of the children belonging to Group 1 was significantly lesser than Group 2 (3 versus 7.5 years; P = .0004). The average duration of surgery was significantly longer in Groups 1 versus 2 (P = .03). The average REBA scores associated with the laparoscopic and robotic approaches were 13 and 5, respectively (P = .0006). The risk indices in both approaches were 3.25 and 1.25, respectively. Conclusion: In a limited cohort of patients, we observed an overall high risk of MSD to the surgeon while performing vesicoscopic ureteric reimplantation. The associated ergonomic risk was significantly less with the robotic (medium risk category) versus laparoscopic approach (very high risk category).