Surgeon's comfort: The ergonomics of a robotic exoscope using a head-mounted display

Study about surgeon's comfort with the RoboticScope

The newest study about RoboticScope is out and released from the Neurosurgical Department of University Clinic Innsbruck. This blog text is a summarization, mostly focused on the results and discussion of the study. The original article you can read here.



The aim of this study was to assess the usability of RoboticScope, as well as neurosurgeon's comfort and ergonomics when working with the RoboticScope in a standardized setting.


As the authors state, the basic design of the traditional surgical microscope with eyepieces is widely used and has remained close to its original development. Due to the unergonomic position that microsurgery often requires, long-term health of surgeons as well as the optimal surgical outcomes for patients are at higher risk. As an answer to these challenges, in recent years, exoscopes have gathered advantages compared to the conventional surgical microscope. Not only a more comfortable posture for the surgeon, but also the technical prospects of fully digitalized image processing and robot movement have been included. (Abramovic et al., 2022)

According to some earlier studies, despite the heads-up posture of the operating surgeon, due to the distance between the surgeon and the monitor, exoscopes still harbor certain limitations regarding especially the depth of the visual field and the visual quality at higher magnification (Ricciardi et al., 2019; Herlan et al., 2019; Gonen et al., 2017).

The RoboticScope was designed to overcome these issues by projecting the images on external displays placed directly in front of the eyes of the surgeon.


To carry out this study and evaluation of RoboticScope, 34 neurosurgeons from University Clinic Innsbruck of different levels of qualification participated in a workshop including a demonstration of the RoboticScope as well as a skill training using a standardized microsurgical training tool.


Each participant received a personal 30-minute user instruction performed by the Clinical Application team of BHS Technologies prior to conduction of the microsurgical skill assessment. After completion of the exercise, image quality and comfort were assessed using a questionnaire. The participants' posture during the exercise was analyzed using a video motion analysis software.

Results & Conclusions

The results of the evaluation were promising. We have selected some of the most interesting outcomes, results, and conclusions for you:


Steep learning curve and intuitive handling


  • “We demonstrated that a robot-controlled exoscope with head-mounted displays and gesture controls can be used comfortably for microsurgery and that introduction and exercise are not time-consuming in comparison to a classical operating microscope.”


  • “The user-friendliness of the RoboticScope interface as well as the possibility to train the relevant commands using a simple microsurgical tool offers excellent conditions for a safe and swift transition towards the exoscope.”


  • “The participants reported an intuitive handling of the RoboticScope supported by the simple user interface.”


  • 88 % of the participants would continue to use the RoboticScope in the operating room. This finding is contrary to previous studies, reporting only 58.9% of the surgeons willing to use monitor-based exoscopes in the OR (Rösler et al., 2021).


Image quality

The image quality as a fundamental parameter in microsurgical operations was reported with a median of 82% overall satisfaction.


Head-Mounted Display, allowing a neutral position during surgery

The majority of participants showed minor median displacement of the upper body from the neutral axis, meaning the participants stayed in a neutral position during the majority of the training session.


The authors state that the advantage of Head-Mounted Display allows a neutral position during surgery, thereby potentially reducing WMSDs (work-related musculoskeletal disorders) and allowing surgeons a more focused and precise handling of the surgical area. They also state that display-based exoscopes, like RoboticScope could play a major key role in the prevention of WMSD-related sick leave, especially in surgeons with high operative caseloads.

Final Statement

The authors state that the RoboticScope excelled in usability, image quality as well as in ergonomic and favorable posture and could thus become an alternative to conventional microscopes due to the potentially elevated surgeons' comfort.


We would like to send our kindest and deepest thanks to the whole neurosurgical team of University Clinic Innsbruck! Thank you to all the surgeons taking part in the evaluation of RoboticScope and special thanks to the authors for writing this article. It is a great help not only for us at BHS Technologies, but also for other clinics possibly being in the process of evaluating new possibilities for surgical visualization.

Original article: Abramovic, Anto & Demetz, Matthias & Krigers, Aleksandrs & Bauer, Marlies & Lener, Sara & Pinggera, Daniel & Kerschbaumer, Johannes & Hartmann, Sebastian & Fritsch, Helga & Thomé, Claudius & Freyschlag, Christian. (2021). Surgeon's comfort: The ergonomics of a robotic exoscope using a head-mounted display. Brain and Spine. 2. 100855. 10.1016/j.bas.2021.100855