Agnieszka Wiernik, Hanna Garnier, Ruta Vilija Dagilyte, Anne-Cecile Oster, Paulina Brauner, Amulya K Saxena
Available evidence suggests that the CH role is an active and demanding component of laparoscopic surgery, with stressors that differ from those experienced by PSs. However, conclusions are limited by the small number of heterogeneous studies and the predominance of adult data. Pediatric evidence is particularly limited and currently relates mainly to ergonomic outcomes.
OBJECTIVE: To evaluate and compare stress exposure between camera-holders (CHs) and primary surgeons (PSs) during laparoscopic surgery across cognitive, physiological, ergonomic, fatigue-related and psychosocial domains.
METHODS: A best evidence review was conducted according to PRISMA guidelines. PubMed, Web of Science, Cochrane Library, Embase and Scopus were searched for studies published between January 2000 and December 2025. Eligible studies reported objective or subjective stress-related outcomes in CHs and/or PSs during laparoscopic surgery. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Owing to heterogeneity in study designs and outcome measures, findings were synthesized narratively.
RESULTS: Seven heterogeneous studies met the inclusion criteria, with only one study specifically evaluating pediatric procedures. Available evidence suggested role-specific patterns of stress exposure. PSs generally reported higher subjective cognitive workload, whereas EEG-based findings suggested comparable cognitive engagement between PSs and CHs. CH-related ergonomic findings included greater trapezius activation, asymmetric loading, non-neutral posture and less favorable viewing angles. Musculoskeletal discomfort was reported in both roles, while one large cross-sectional study found greater intraoperative fatigue and psychosocial stress related to image control and negative verbal interactions among CHs. The single pediatric study identified less favorable viewing angles and greater procedural discomfort among CHs than PSs.
CONCLUSION: Available evidence suggests that the CH role is an active and demanding component of laparoscopic surgery, with stressors that differ from those experienced by PSs. However, conclusions are limited by the small number of heterogeneous studies and the predominance of adult data. Pediatric evidence is particularly limited and currently relates mainly to ergonomic outcomes.