Introduction Work-related musculoskeletal disorders are highly prevalent among surgeons and are primarily associated with sustained non-neutral postures, inadequate visualization, improper table height, and insufficient adaptation to individual anthropometry; therefore, this systematic review aimed to synthesize evidence on ergonomic risk factors and define evidence-based parameters for safer surgical practice. Methods A comprehensive systematic search of multiple databases was conducted using predefined eligibility criteria, including studies evaluating surgeon anthropometry, visualization techniques, table height, muscle activity, posture, and ergonomic accessories; findings were qualitatively synthesized across predetermined ergonomic domains such as neutral posture, electromyographic fatigue, spinal kinematics, and ergonomic modifications. Results Twenty-six studies across laparoscopic, endoscopic, microscopic, otolaryngologic, neurosurgical, and urological procedures were included. Beneficial ergonomic ranges included cervical flexion of 0–10°, shoulder abduction below 30°, trunk inclination under 20°, and minimal neck rotation. Ergonomic redesign reduced trapezius fatigue from 100 to 42%, while monitor-based endoscopy decreased trapezius activity to approximately one-third compared with direct eyepiece viewing. Optimal table height varied widely, commonly defined relative to elbow height or surgeon stature, with required ranges (29–122 cm) exceeding standard table capabilities. Discussion Surgeon ergonomics is strongly influenced by operating room design, visualization setup, and anthropometric variability, and current equipment frequently fails to meet evidence-based requirements, supporting the need for redesigned surgical tables, improved visualization systems, and integrated ergonomic accessories to reduce strain and enhance long-term occupational sustainability.