Enhancing Cognitive Ergonomics in Robotic Surgery—A Narrative Review

Robotic-assisted surgery (RAS) has transformed minimally invasive procedures by improving physical ergonomics, surgical field visualisation and instrument manipulation. However, RAS introduces unique cognitive load for the surgeon. Cognitive ergonomics aims to enhance the mental resources to optimise the interactions between surgeons and their environment, thereby improving the wellbeing and performance of surgeons and patient outcomes. Current evidence highlights that RAS redistributes, rather than eliminates, ergonomic burden from the physical to the mental domain. Subjective measurement tools remain the most widely used; however, physiological measures offer continuous and real-time data regarding cognitive workload fluctuations during surgery. Strategies to improve cognitive ergonomics include surgeon-level strategies, interface and system design alterations, operating room workflow optimisation, incorporation of artificial intelligence, and training and education. This narrative review summarises the current evidence regarding the mental demands associated with RAS, cognitive workload measures, the consequences of poor cognition, and emerging strategies to improve cognitive ergonomics in RAS.