PURPOSE: As bariatric surgery volumes continue to rise globally, concerns regarding occupational musculoskeletal injury and surgeon wellbeing have become increasingly prominent. Minimally invasive surgery is associated with substantial ergonomic strain; however, the comparative risks of bariatric robotic and laparoscopic approaches remain incompletely characterised. METHODOLOGY: A mixed-methods systematic review without meta-analysis was conducted in accordance with PRISMA guidelines and a prospectively registered protocol (PROSPERO ID: CRD420251109094). Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science were searched from database inception to 02/08/2025. RESULTS: Of 5,849 records identified, 181 full-text articles were assessed, with 11 studies included, collectively representing at least 183 bariatric surgeons and 307 procedures. Objective ergonomic assessments demonstrated higher overall ergonomic risk and greater upper-extremity burden during laparoscopic bariatric surgery compared with robotic surgery. Robotic surgery was associated with region-specific trade-offs, including increased wrist loading and static trunk demands, suggesting redistribution rather than elimination of biomechanical strain. Subjective ergonomic outcomes were heterogeneous. Cross-sectional studies consistently reported a high prevalence of work-related musculoskeletal issues among bariatric surgeons, affecting up to 66%. Qualitative findings highlighted limited ergonomics training and ergonomic strain impacting fatigue and career longevity. CONCLUSION: This is the first systematic review to specifically synthesise surgeon ergonomics in bariatric surgery. Robotic bariatric surgery demonstrates a more favourable objective ergonomic profile with reduced upper-extremity loading. Interpretation is limited by heterogeneity in study design and ergonomic measures. Future research should prioritise ergonomic interventions and structured ergonomics training to promote surgeon wellbeing.