Quantifying ergonomic challenges for urologists operating flexible ureteroscopes through artificial intelligence-based posture estimation

Clinical Snapshot

Key Findings

• P Value: Multiple significant differences: left shoulder p < 0.001, left wrist p < 0.001, task completion p < 0.001

• Effect Size: Experts had 2.4-fold less left shoulder travel distance (125 vs 300 cm) and 5.2-fold less left wrist travel distance (729 vs 3798 cm)

• Primary Outcome: Kinematic differences between expert and novice urologists during flexible ureteroscopy

• Nnt Or Sensitivity: Task completion time: experts 58s vs novices 102s (43% faster)

• Confidence Interval: Not reported

Clinical Application

Technology requires specialized equipment but could be implemented in training centers Relevant to Australian urology training programs and workplace safety initiatives. Could inform RACS surgical training curricula and support TGA considerations for robotic ureteroscopy systems Urologists performing flexible ureteroscopy, particularly relevant for training programs and ergonomic assessment

Abstract

PURPOSE: The ergonomic challenges faced by surgeons during flexible ureteroscopy have yet to be thoroughly evaluated using objective methods. However, robot-assisted ureteroscopy has emerged as a promising treatment for urinary stones. The present study quantitatively assesses operative posture during transurethral ureteroscopy via an artificial intelligence-based posture estimation framework, and identifies kinematic differences associated with surgical expertise. METHODS: Expert and novice urologists performed standardized flexible ureteroscopic tasks in a simulated transurethral ureteroscopy environment using kidney phantoms containing artificial stones. Upper-body movements were continuously video-recorded and joint coordinates of the shoulders, elbows, and wrists were extracted using an artificial intelligence-based pose estimation system. Kinematic parameters were quantitatively analyzed and compared between groups. RESULTS: Experts completed observation of the entire renal pelvis significantly faster than novices (median 58 vs. 102 s, p < 0.001). Accumulated travel distance was markedly less in experts for the left shoulder (125 vs. 300 cm, p < 0.001), right elbow (324 vs. 1035 cm, p = 0.028), left elbow (349 vs. 772 cm, p = 0.019), and left wrist (729 vs. 3798 cm, p < 0.001). Experts had smaller movement areas at the left shoulder (6.29 vs. 40.5 cm2, p < 0.001) and right elbow (17.3 vs. 281 cm2, p = 0.040), and reduced movement ranges across multiple joints. Their angle fluctuation ranges were also narrower for the right shoulder (32.0 vs. 76.3°, p = 0.028) and left elbow (70.4 vs. 122.4°, p < 0.001). CONCLUSIONS: The artificial intelligence-based posture analysis objectively demonstrated ergonomic advantages associated with surgical expertise during flexible ureteroscopy and revealed persistent ergonomic risks to the wrist and elbow.

References

1. 1.Kobayashi, S., Tsukino, K., Koura, M., Tanegashi, T., Tsukahara, S., Matsumoto, T., Shiota, M., & Eto, M. (2026). Quantifying ergonomic challenges for urologists operating flexible ureteroscopes through artificial intelligence-based posture estimation. World Journal of Urology. https://doi.org/10.1080/10803548.2022.2154483