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Page 6 of 8 Kavalukas et al. Mini-invasive Surg 2020;4:61 I http://dx.doi.org/10.20517/2574-1225.2020.71

CONCLUSION
Robotic surgery has gained widespread popularity for many reasons. Ergonomically, many surgeons prefer
the robot console for comfort over the course of lengthy operations. Workplace overuse injuries specific
to laparoscopic surgery can include neck, lower back, and wrist ailments, due to instrument handling and
monitor positioning. The reported percentage of musculoskeletal disorders ranges from 73%-100% for
[44]
laparoscopic surgery and 23%-80% for robotic surgery . Electromyography has been used to compare
muscle activation between laparoscopic and robotic surgery, revealing that muscle activation was higher
[45]
in most muscle groups in laparoscopic compared to robotic surgeons . The only muscle group that did
not show significant difference in activation was the trapezius, and this was correlated to poor positioning
[46]
of the robotic eyepiece. Lee et al. surveyed 432 exclusively robotic surgeons and reported that 56% of
surgeons still have discomfort manifested by eye strain, neck stiffness, and finger fatigue, as well as lower
back stiffness with increased surgical volumes.

This review of the literature clearly demonstrates both minimally invasive techniques to be equivalent in
terms of meaningful perioperative outcomes, though intraoperative costs are consistently higher for robotic
surgery. One must be careful when evaluating the data as there are many unmeasurable confounding
factors that may affect outcomes. Conversion rates may be misrepresented in favour of robotic surgery
if complicated cases with an anticipated high likelihood of conversion to open surgery were planned
laparoscopically to save time docking the robot. Operative times may be misrepresented as none of the
data evaluated teaching atmospheres and time given to the surgical trainee vs. the attending physician. The
narrow length of stay differences may be affected by preoperative delays or postoperative transportation
availability. Despite all these possibilities, the two platforms continue to show negligible differences that do
not reach statistical significance in almost all studies. The robotic platform may boast a shorter learning
curve, though it should be noted in many of these cases the surgeon already has laparoscopic experience
performing the procedure and understanding the planes of dissection.

Much effort has been spent evaluating the difference between these platforms. However, the incision,
extraction site, surgeon, and operation are the same, save for the advanced capabilities inherent in the
robotic instruments. The ultimate decision on whether to perform robotic vs. laparoscopic surgery should
be based on surgeon preference and familiarity with equipment, as well as local resources.

DECLARATIONS
Authors’ contributions
Manuscript preparation: Kavalukas SL, Ghuman A, Sharp SP
Manuscript review and Editing: Wexner SD

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Dr Wexner is a paid consultant and receives royalties for intellectual property license from Intuitive
Surgical, Medtronic, and Karl Storz and is a paid consultant for Stryker. all other authors declared that there
are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.