Exoskeletons in surgery: support in straining situations

Standing for hours, arms raised, hardly any freedom of movement: working in the operating room requires not only concentration but also peak physical performance from surgical staff. Exoskeletons, a technology originally developed for industry and logistics, can relieve the strain on surgeons during operations.

As passive or active assistance systems in medicine, exoskeletons can help reduce muscle fatigue and maintain precision and concentration during surgery. In recent years, clinics have begun to integrate them into the operating room.

Surgery is not just mentally demanding: surgeons and assistants often remain in a more or less rigid position with their arms raised for hours at a time. These static strains put stress on the shoulder girdle, back, and neck. Standing at the table for long periods of time also puts strain on the thighs and knees. During an operation, no one can "stretch their legs."

In the long term, working in the operating room can lead to musculoskeletal complaints. In the worst case, shoulder or back problems can even develop into occupational diseases. The result: long periods of absence and an exacerbation of the shortage of skilled workers. You can read more about this in part 2 of our series on exoskeletons.

This is where exoskeletons for surgeons come into play: an exoskeleton is a wearable system that relieves muscles and bones during physical work. Passive models are usually used in the operating room. These do not require electricity, but either transfer the weight of the arms to the hips or back via straps and springs, or are static, adjustable systems that support the body. Both significantly relieve the postural muscles without significantly restricting the surgeon's freedom of movement.

This helps to delay fatigue and maintain concentration and precision for longer during the operation. In the long term, this also has the potential to prevent complaints from becoming chronic.

In the operating room, every movement counts for patient safety and the best treatment success. It is therefore crucial that an exoskeleton does not hinder surgery. Lightweight construction, easy donning and doffing, and unrestricted access to the surgical field are minimum requirements. Still, hygiene standards and the correct wearing of surgical clothing must not be compromised.

For successful integration into the operating room, the clinic must provide comprehensive training and communicate transparently with the team about implementation. Users, in turn, must demonstrate technical acceptance. Individual adjustments and integration into training programs can significantly increase willingness to use the device.

As early as 2020, Ottobock's passive Paexo Shoulder exoskeleton was supporting work in operating rooms at various hospitals in the DACH region (Germany, Austria, and Switzerland). It was later replaced by the IX Should Air exoskeleton from SUITX by Ottobock. Its effectiveness has been confirmed in several studies. Those involved reported a noticeable reduction in strain during surgery.

In the US, a pilot study by the Mayo Clinic investigated the integration of an exoskeleton in vascular surgery. The surgeons wore a passive arm support system. The device was found to be compatible with operating room requirements in almost all procedures, with no restrictions in mobility or precision reported. The participants advocated for its continued use in the clinic.

Four US universities tested a passive upper body exoskeleton for surgical assistants that provides support when wearing lead aprons. Sensors recorded muscle activity, posture, and movement patterns. The results showed a reduction in unergonomic arm positions and less strain on the shoulder muscles.

One example of current research in Germany is the BiSOP project – Biomechatronic Systems for Improving Ergonomics in the Operating Room (German website), carried out at Chemnitz University of Technology. The aim is to develop a hand exoskeleton to relieve strain on the hand and arm muscles during surgery.

Exoskeletons offer a promising way to specifically reduce physical strain in the operating room. They protect the back, shoulders, arms, and legs, contribute to the performance of the surgical team, and could help minimize illness-related absences in the long term. This makes them not only a technological advance in medicine, but also a contribution to occupational safety and health protection in the surgical environment. If their integration into the clinic is carefully planned, both surgical staff and patients will ultimately benefit.