BACKGROUND: This study aims to implement a set of wearable technologies to record and analyze the surgeon’s physiological and ergonomic parameters during the performance of conventional and robotic-assisted laparoscopic surgery, comparing the ergonomics and stress levels of surgeons during surgical procedures. METHODS: This study was organized in two different settings: simulator tasks and experimental model surgical procedures. The participating surgeons performed the tasks and surgical procedures in both laparoscopic and robotic-assisted surgery in a randomized fashion. Different wearable technologies were used to record the surgeons’ posture, muscle activity, electrodermal activity and electrocardiography signal during the surgical practice. RESULTS: The simulator study involved six surgeons: three experienced (>100 laparoscopic procedures performed; 36.33 ± 13.65 years old) and three novices (100 laparoscopic procedures performed; 37.00 ± 5.29 years old), but without experience in surgical robotics, participated in the experimental model study. The participating surgeons showed an increased level of stress during the robotic-assisted surgical procedures. Overall, improved surgeon posture was obtained during robotic-assisted surgery, with a reduction in localized muscle fatigue. CONCLUSIONS: A set of wearable technologies was implemented to measure and analyze surgeon physiological and ergonomic parameters. Robotic-assisted procedures showed better ergonomic outcomes for the surgeon compared to conventional laparoscopic surgery. Ergonomic analysis allows us to optimize surgeon performance and improve surgical training.

Background/Objectives: Among the scientific literature, the significant potential of the application of artificial intelligence (AI) in minimally invasive surgery (MIS) stands out. The aim of this study is to provide a comprehensive review to analyze the scientific literature on AI applications in MIS training, selecting the main applications, limitations, opportunities and challenges in this field of research. Methods/Design: A literature search was conducted in scientific databases. The search was performed with titles or abstracts, using keywords. First, studies unrelated to the topic of study were eliminated. Next, the selection was limited to articles in English. The exclusion criteria for the search were reviews, letters, case reports, industrial articles and conference abstracts. Next, only studies published in the last ten years (2014–2024) were evaluated, with priority given to publications in the last five years (2019–2024) in surgical training in AI and MIS. Finally, the full text was reviewed to add or exclude the study from this review. Results: Of the 54 studies included in this review, 18 studies were related to skills assessment, 30 studies analyzed aspects of surgical training itself, 12 studies were related to learning aspects of surgical planning, 7 studies were based on gesture recognition and 3 studies were based on surgical action recognition to measure surgical performance during MIS training. A brief description of the main AI techniques was included in this review. Conclusions: The application of AI in MIS surgical training is still a developing field of research, which presents great potential for exploring future applications, challenges, opportunities and drawbacks, as well as synergies between the technical and clinical research fields.

BACKGROUND: This study aims to continue research on the objective analysis of ergonomic conditions in robotic-assisted surgery (RAS), seeking innovative solutions for the analysis and prevention of ergonomic problems in surgical practice. METHODS: Four different robotic-assisted tasks were performed by groups of surgeons with different surgical experiences. Different wearable technologies were used to record surgeons’ posture and muscle activity during surgical practice, for which the correlation between them was analyzed. A predictive model was generated for each task based on the surgeons’ level of experience and type of surgery. Two preprocessing techniques (scaling and normalization) and two artificial intelligence techniques were tested. RESULTS: Overall, a positive correlation between prolonged maintenance of an ergonomically inadequate posture during RAS and increased accumulated muscle activation was found. Novice surgeons showed improved posture when performing RAS compared to expert surgeons. The predictive model obtained high accuracy for cutting, peg transfer, and labyrinth tasks. CONCLUSIONS: This study expands on the existing ergonomic analysis of the lead surgeon during RAS and develops predictive models for future prevention of ergonomic risk situations. Both posture and muscle loading are highly related to the surgeon’s previous experience.

Precise intraoperative identification of the canine thoracic duct remains challenging due to anatomical variability and limited visualization. This exploratory cadaveric feasibility study aimed to describe the technical applicability of fluorescence-guided thoracic duct mapping using video-assisted thoracoscopy (VATS) and robot-assisted thoracoscopy (Versius™ system). Four adult Beagle cadavers underwent bilateral thoracoscopic exploration after intranodal injection of indocyanine green (ICG, Verdye^®, 0.05 mg/kg; 0.5 mL). Near-infrared (NIR) fluorescence imaging enabled real-time visualization of the thoracic duct and its branches. Fluorescence quality was quantitatively characterized using signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast resolution (CR) calculated from standardized image frames. Both approaches achieved successful duct identification in all cadavers. VATS provided brighter overall fluorescence, whereas the robotic-assisted approach offered stable imaging, enhanced instrument dexterity, and improved duct-to-background discrimination. These findings confirm the feasibility of fluorescence-guided thoracic duct identification using both minimally invasive modalities in canine cadavers. The standardized assessment of optical parameters proposed here may support future in vivo studies to optimize imaging protocols and evaluate the clinical impact of fluorescence-guided thoracic duct surgery in dogs.