• Surgery

The use of robots in surgery does not always lead to correct postures in the workers. Several authors assessed surgical personnel during their work using RULA and other tools. They found detrimental results and the need to modify the tasks [190,215]. One solution could be to provide ergonomic training to workers who perform surgery with robots. According to RULA, this improved the levels of risk [195]. The use of robot in other cases led to ergonomic improvements. One of these was when performing endoscopies. Surgeons obtained lower RULA scores when using robots than when performing the operation manually [224].

Other authors focused their studies (using the RULA method) on surgeons performing laparoscopies. They showed that there was a risk regarding the postures the surgeons developed [197]. In some cases, they combined these studies with the use of new technologies. For example, Youssed et al. [218] used a virtual reality simulator in this type of study, whereas Sanchez-Margallo et al. [221] used a glove called a CyberGlove (R). This glove allowed one to measure the movements made by the wrist, which can then be applied to an adapted RULA method. Bensignor et al. [201] designed a robotic needle holder for this type of surgery. Using RULA, they demonstrated that surgeon's postures were less harmful than when performing the technique in the traditional way.

Other ergonomic analyses were performed on surgeons carrying out various tasks. Li et al. [196] used RULA to assess plastic surgeons who used magnifying glasses, and who suffered discomfort in the upper extremities. They indicated that modifying the height of the table or the distance of the magnifying glass from the workplace could lessen these problems. Person et al. [225] used an optoelectronic system to take posture data and obtain results using a modified RULA. They found harmful results mainly at the wrist. Hermandon and Choi [217] agreed that the wrist was one of the hardest-hit areas. They used RULA and other tools on office-based surgery (OBS) workers. They concluded that these workers were at high risk of musculoskeletal disorders. In addition, they highlighted other areas of the body that were harmed such as the arms, shoulder, neck and back.

Other authors assessed surgeons' postures using RULA when they performed the same procedure in different ways. For example, Statham et al. [220] focused on laryngeal microsurgery surgeons. They assessed them while performing the task adopting three different postures, one with the arms unsupported and the other two with different supports. They deduced the levels of risk to which the surgeons were exposed. Singh et al. [200] assessed gynaecology surgeons using four different chairs. They determined a medium-to-high risk in the neck and shoulders. They showed that the chairs did not influence the scores.

Finally, some authors presented the idea of integrating different ergonomic methods and tools to assess nursing and surgery workers. OWAS, REBA, RULA and NIOSH were used, amongst other methods [209].
