Introduction/Background Robotic surgery has advantages over laparoscopic surgery, including 3D vision, greater precision, articulated instruments, improvement of the surgical field and ergonomics.The aim of this study is to evaluate if robotic surgery improves ergonomic in different surgical procedures compared to laparoscopic surgery in gynecological cancer.

Methodology Comparative study between robotic and laparoscopic surgery carried out in a tertiary hospital from 2007 to 2019. Data from a survey completed by surgeons after each surgical procedure for gynecological cancer were analyzed. Patients operated were diagnosed of endometrial, ovarian or cervical carcinoma.The survey evaluated ergonomics parameters with scores between 1 and 10 in both surgical approaches in different surgical procedures.Surgical procedures were grouped according technical difficulty: hysterectomy with double adnexectomy, hysterectomy with lymphadenectomy (pelvic or pelvic and para-aortic), radical hysterectomy and para-aortic lymphadenectomy.Basic demographic characteristic and ergonomics were compared between both approaches.

Results A total of 534 surveys were collected, 347 in the robotic group and 187 in conventional laparoscopic group.Patients in the robotic surgery group had a higher BMI, greater morbidity and therefore higher ASA scores.No differences were observed between robotic and laparoscopic surgery groups regarding the question related to the degree of difficulty of the surgery perceived by the surgeon (p=0.151).The group of robotic surgery obtained lower scores on questions related to fatigue (Robotic 3.2 vs Laparoscopic 5.5), comfort (Robotic 9.1 vs Laparoscopic 6.4), and limb (Robotic 1.3 vs Laparoscopic 4.4) and back pain (Robotic 1.8 vs Laparoscopic 4.3). Statistically significant differences were observed in questions related to the surgeon’s fatigue (p=0.000), the degree of comfort (p=0.000) and limb or back pain (p=0.000).

Conclusion Robotic surgery improves the ergonomics of surgery for gynecological cancer patients in different surgical procedures with several degrees of difficulty.