Impact of a full clinical workday on surgical performance in simulated laparoscopy: a controlled crossover trial

BACKGROUND: Laparoscopic surgery places musculoskeletal demands on surgeons, which may be exacerbated by daily clinical activity. The effect of a workday on simulated laparoscopic performance and musculoskeletal parameters remains poorly understood. OBJECTIVE: To assess the impact of a clinical workday on simulated laparoscopic performance, muscle activation, postural control, and perceived workload. METHODS: In this randomized controlled crossover study, 29 gynecologic surgeons (16 novices, 13 experts) performed a standardized suturing and knot-tying task on a pelvic simulator during two sessions: morning before clinical duties and evening after a full workday. Surface electromyography assessed muscle activation, and a force platform measured center-of-pressure parameters during the task. Participants completed questionnaires on fatigue, shoulder tension, effort, and workload (NASA-TLX, SURG-TLX). RESULTS: Suturing performance was similar between sessions (698 ± 203 vs 683 ± 212 s; p = 0.54). Participants reported higher perceived effort (p < 0.005), fatigue (p < 0.001), and dominant-shoulder tension (p = 0.019) after the workday. NASA-TLX scores remained unchanged, but SURG-TLX showed a trend toward higher mental demand (p = 0.051) and a significant increase in distraction (p = 0.014). Postural analysis revealed reduced antero-posterior center-of-pressure velocity after the workday (p = 0.017). CONCLUSION: A clinical workday does not impair technical laparoscopic performance but induces increases in perceived workload, shoulder tension, and postural adaptations during simulated suturing. These findings highlight the hidden ergonomic cost of daily gynecologic surgical activity and support ergonomic training and workload management strategies in minimally invasive gynecology.