A Scoping Review of the Ergonomics of Handheld Surgical Robots

Handheld surgical robots aim to improve dexterity with lower cost and footprint than console systems, but their ergonomic impact is unclear. We performed a scoping review (inception − 27 July 2025) of English-language primary studies of handheld robotic instruments across six databases and targeted grey literature. Dual-reviewer screening and charting were used, with narrative synthesis. From 2,675 records, 79 studies met inclusion: 21 evaluated ergonomics. Most relied on subjective questionnaires; validated workload tools (NASA-TLX/SURG-TLX) and objective measures (RULA, wearables) were uncommon. Twelve commercial systems were identified; only three had peer-reviewed ergonomic data. Reported ergonomic aims included reducing weight, maintaining neutral wrist posture and intuitive control mapping; sex-disaggregated outcomes were rare. Evidence remains heterogeneous and insufficiently standardised; we recommend hybrid, validated protocols and inclusive design to ensure safe, equitable adoption.