Ergonomic advantages of the open console system in robotic colorectal resection: reduced musculoskeletal strain with preserved technical performance – a post hoc analysis of a randomized controlled trial

PURPOSE: Although robotic surgery has advanced minimally invasive techniques, its ergonomic limitations pose significant musculoskeletal risks to surgeons. This study evaluated whether the Kangduo SR-01 (KD) open console system mitigates intraoperative ergonomic strain while preserving technical performance during robotic colorectal resection. METHODS: This study utilized data from a multicenter randomized controlled non-inferiority trial comparing the efficacy and safety of KD versus Da Vinci (DV) robotic systems in assisting colorectal cancer resection. The assessment framework included ergonomic strain (Borg CR-10 Scale), team coordination (Oxford NOTECHS II), and blinded video-based technical performance analysis [Objective Structured Assessment of Technical Skills (OSATS)]. RESULTS: A total of 100 patients were included in the modified intention-to-treat analysis: 50 in the KD group and 50 in the DV group. Body mass index (BMI) and resection types were comparable between groups. Postural demands were significantly higher for neck and back during DV procedures. Discomfort increased significantly more over time (up to 3 h) in the DV group for both neck [MD (95% c.i.) -0.889 (-1.077, -0.701), P < 0.001] and back [MD (95% c.i.) -0.606 (-0.847, -0.364), P < 0.001]. Notably, both systems achieved equivalent technical proficiency (OSATS total: 29.0 vs. 29.0, P = 0.259) and team coordination (NOTECHS II: 74.0 vs. 73.0, P = 0.120) with comparable short-term outcomes. CONCLUSIONS: The Kangduo SR-01 open console system significantly alleviated musculoskeletal strain, particularly in the neck and back, during robotic colorectal surgery while maintaining equivalent technical performance. These findings position open console platforms as a viable solution to ergonomic challenges in robotic surgery without compromising team dynamics or procedural efficiency.