Feasibility of Insole-Derived Plantar Pressure Measures for Evaluating Standing-Related Parameters in Open and Laparoscopic Surgery

Prolonged standing is a common feature of many occupations and is associated with an increased risk of musculoskeletal and cardiovascular disorders. Surgeons are particularly exposed, as surgical procedures require extended periods of static standing under physically demanding conditions. Despite this, objective data quantifying standing behavior and postural control in real surgical environments remain limited. This study evaluated the feasibility of real-world monitoring of balance and standing-related behaviors during surgery using wearable insole sensors. The aims were to quantitatively characterize standing behavior in surgeons and to investigate potential differences between open and laparoscopic procedures. Eighteen full-time surgeons were monitored during 10 laparoscopic and 8 open surgeries. Ground reaction forces and acceleration signals were used to identify static standing bouts, classify their duration, and quantify load-bearing asymmetry, fidgeting, and weight shifting. Multivariate analyses compared these parameters between surgical approaches. Open surgeries were characterized by significantly greater time spent in static standing (>90%) than laparoscopic procedures (~64%) and by a higher prevalence of prolonged bouts exceeding 10 minutes. However, both approaches showed substantial load-bearing asymmetry: during approximately 30% of static standing time, surgeons supported more than 80% of their body weight on one limb, with no significant difference between procedures. Similarly, fidgeting and weight shifting did not differ between approaches, suggesting that these micromovements reflect individual compensatory strategies rather than task-specific demands. Overall, wearable insole sensors provide a feasible and objective method to characterize static standing, asymmetry, and micromovements in real surgical settings, supporting the identification of early indicators of musculoskeletal overload and informing ergonomic interventions.