Background <p>Previous work has examined the ergonomics of surgical procedures and the effect exoskeletons may have to support surgeons. However, hernia repair procedures are often dynamic, and current literature has yet to deduce physical demands across key segments of these procedures and examine how exoskeletons support surgeons across each of these segments.</p> Methods <p>Four surgeons completed a total of 45 open and laparoscopic hernia repair procedures with and without a shoulder-support exoskeleton. Muscle activity and posture during control conditions (i.e., no exoskeleton) were used to characterize the physical demands of hernia repair procedures and were compared to the shoulder-support condition using a linear mixed effects model and t-test respectively.</p> Results <p>Mesh deployment was identified as the most demanding segment for open hernia repair procedures and Preparing mesh was the most demanding for laparoscopic procedures. It was found that the shoulder-support exoskeleton reduced muscle activity in the upper trapezius at the expense of increased erector spinae muscle activity and increased neck flexion. During open procedures the shoulder-support exoskeleton largely increased muscle activity across each segment during laparoscopic procedures, but reduced trunk, shoulder, and neck flexion.</p> Conclusion <p>The most demanding segments of hernia repair procedures were identified which may be targeted in future interventions to support the physical demands experienced by surgeons. Shoulder-support exoskeletons may be more appropriate for open hernia repair procedures and potentially detrimental for laparoscopic hernia repair procedures.</p>