Skip to main content
SpringerLink
Log in

Surgeons’ display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Research has demonstrated the benefits of robotic surgery for the patient; however, research examining the benefits of robotic technology for the surgeon is limited. This study aimed to adopt validated measures of workload, mental effort, and gaze control to assess the benefits of robotic surgery for the surgeon. We predicted that the performance of surgical training tasks on a surgical robot would require lower investments of workload and mental effort, and would be accompanied by superior gaze control and better performance, when compared to conventional laparoscopy.

Methods

Thirty-two surgeons performed two trials on a ball pick-and-drop task and a rope-threading task on both robotic and laparoscopic systems. Measures of workload (the surgery task load index), mental effort (subjective: rating scale for mental effort and objective: standard deviation of beat-to-beat intervals), gaze control (using a mobile eye movement recorder), and task performance (completion time and number of errors) were recorded.

Results

As expected, surgeons performed both tasks more quickly and accurately (with fewer errors) on the robotic system. Self-reported measures of workload and mental effort were significantly lower on the robotic system compared to the laparoscopic system. Similarly, an objective cardiovascular measure of mental effort revealed lower investment of mental effort when using the robotic platform relative to the laparoscopic platform. Gaze control distinguished the robotic from the laparoscopic systems, but not in the predicted fashion, with the robotic system associated with poorer (more novice like) gaze control.

Conclusions

The findings highlight the benefits of robotic technology for surgical operators. Specifically, they suggest that tasks can be performed more proficiently, at a lower workload, and with the investment of less mental effort, this may allow surgeons greater cognitive resources for dealing with other demands such as communication, decision-making, or periods of increased complexity in the operating room.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. While there were no significant differences between the qualified and trainee surgeons in terms of number of errors, the qualified surgeons completed the task quicker on the laparoscopic system. Furthermore, although number of previous laparoscopic procedures was not related to performance on this task on either system, number of prior robotic procedures was related to performance on this task on the robotic system.

  2. While there was no significant difference in the time it took the qualified and trainee surgeons to complete this task on the robotic system, the qualified surgeons completed the task quicker on the laparoscopic system. Moreover, although number of previous laparoscopic procedures was not related to performance on this task on either system, number of prior robotic procedures was related to performance on this task on the robotic system.

References

  1. Payne TN, Dauterive FR (2008) A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15:286–291

    Article  PubMed  Google Scholar 

  2. Trinh Q, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, Jeong W, Shariat SF, Hansen J, Schmitges J, Jeldres C, Rogers CG, Peabody JO, Montorsi F, Menon M, Karakiewick PI (2012) Preoperative outcomes of robot-assisted radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 61:679–685

    Article  PubMed  Google Scholar 

  3. Hakimi AA, Blitstein J, Feder M, Shaprio E, Ghavamian R (2009) Direct comparison of surgical and functional outcomes of robotic-assisted versus pure laparoscopic radical prostatectomy: single-surgeon experience. Urology 73:119–123

    Article  PubMed  Google Scholar 

  4. Hubert N, Gilles M, Desbrosses K, Meyer JP, Felblinger J, Hubert J (2013) Ergonomic assessment of the surgeon’s physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot Comput Assist Surg 9:142–147

    Article  CAS  Google Scholar 

  5. Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR (2014) Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 28:456–465

    Article  PubMed  Google Scholar 

  6. Stefanidis D, Hope WW, Scott DJ (2011) Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favoured by more surgeons compared with laparoscopy. Surg Endosc 25:2141–2146

    Article  PubMed  Google Scholar 

  7. Stefanidis D, Wang F, Korndorffer JR Jr, Dunne JB, Scott DJ (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24:377–382

    Article  PubMed  Google Scholar 

  8. Panait L, Shetty S, Shewokis PA, Sanchez JA (2014) Do laparoscopic skills transfer to robotic surgery? J Surg Res 187:53–58

    Article  PubMed  Google Scholar 

  9. Hart S, Staveland L (1988) Development of Nasa-Tlx (Task Load Index): Results of empirical and theoretical research. Hum Ment Workload 1:139–183

  10. Wilson MR, Poolton JM, Malhotra N, Ngo K, Bright E, Masters RSW (2011) Development and validation of a surgical workload measure: the surgery task load index (SURG-TLX). World J Surg 35:1961–1969

    Article  PubMed Central  PubMed  Google Scholar 

  11. Hilburn B, Jorna PGAM (2001) Workload and air traffic control. In: Hancock PA, Desmond PA (eds) Stress, workload and fatigue. Lawrence Erlbaum Associates, New Jersey, pp 384–394

    Google Scholar 

  12. Healey AN, Sevdalis N, Vincent CA (2006) Measuring intraoperative interference from distraction and interruption observed in the operating theatre. Ergonomics 49:589–604

    Article  CAS  PubMed  Google Scholar 

  13. Wilson MW, Smith NC, Holmes PS (2007) The role of effort in mediating the anxiety performance relationship: testing the conflicting predictions of the processing efficiency theory and the conscious processing hypothesis. Br J Psychol 98:411–428

    Article  PubMed  Google Scholar 

  14. Hubens G, Coveliers H, Balliu L, Ruppert M, Vaneerdeweg W (2003) A performance study comparing manual and robotically assisted laparoscopic surgery using the da Vinci system. Surg Endosc 17:1595–1599

    Article  CAS  PubMed  Google Scholar 

  15. Wilson M, McGrath J, Vine S, Brewer J, Defriend D, Masters R (2010) Psychomotor control in a virtual laparoscopic surgery training environment: gaze control parameters differentiate novices from experts. Surg Endosc 24:2458–2464

    Article  PubMed Central  PubMed  Google Scholar 

  16. Wilson MR, McGrath JS, Vine SJ, Brewer J, Defriend D, Masters RSW (2011) Perceptual impairment and psychomotor control in virtual laparoscopic surgery. Surg Endosc 25:2268–2274

    Article  PubMed Central  PubMed  Google Scholar 

  17. Wilson MR, Vine SJ, Bright E, Masters RSW, Defriend D, McGrath JS (2011) Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study. Surg Endosc 25:3731–3739

    Article  PubMed Central  PubMed  Google Scholar 

  18. Vine SJ, Masters RSW, McGrath JS, Bright E, Wilson MR (2012) Cheating experience: guiding novices to adopt the gaze strategies of experts expedites the learning of technical laparoscopic skills. Surgery 152:32–40

    Article  PubMed  Google Scholar 

  19. Vine SJ, Chaytor RJ, McGrath JS, Masters RSW, Wilson MR (2013) Gaze training improves the retention and transfer of laparoscopic technical skills in novices. Surg Endosc 27:3205–3213

    Article  PubMed  Google Scholar 

  20. Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR (2002) Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Adult Urol 60:39–45

    Article  Google Scholar 

  21. Zijlstra FRH (1993) Efficiency in work behaviour: a design approach for modern tools. Delft University Press, Delft

    Google Scholar 

  22. Carrasco S, Gaitan MJ, Gonzalez R, Yanez O (2001) Correlation among poincare plot indexes and time and frequency domain measures of heart rate variability. J Med Eng Technol 25:240–248

    Article  CAS  PubMed  Google Scholar 

  23. Mulder G, Mulder LJM, Meijman TF, Veldman JBP, Van Roon AM (2000) A psychophysiological approach to working conditions. In: Backs RW, Boucsein W (eds) Engineering psychophysiology: Issues and applications. Lawrence Erlbaum Associates, Mahwah, pp 139–159

    Google Scholar 

  24. Tarvainen MP, Niskanen JP, Lipponen JA, Ranta-Aho PO, Karjalainen PA (2014) Kubios HRV—Heart rate variability analysis software. Comput Meth Prog Bio 113:210–220

  25. Ober JK, Przedpelska-Ober E, Gryncewicz W, Dylak J, Carpenter RHS, Ober JJ (2003) Hand-held system for ambulatory measurement of saccadic durations of neurological patients. In: Gadja J (ed) modelling and measurement in medicine Komitet Biocybernityki i Inzynneierii Biomedycznej. PAN, Warsaw, pp 187–198

    Google Scholar 

  26. Vickers JN (2011) Mind over muscle: the role of gaze control, spatial cognition, and the quiet eye in motor expertise. Cogn Process 12:219–222

    Article  PubMed  Google Scholar 

  27. Klein MI, Warm JS, Riley MA, Matthews G, Doarn C, Donovan JF, Gaitonde K (2012) Mental workload and stress perceived by novice operators in the laparoscopic and robotic minimally invasive surgical interfaces. J Endouro 26:1089–1094

    Article  Google Scholar 

  28. Klein MI, Mouraviev V, Craig C, Salamone L, Plerhoples TA, Wren SM, Gaitonde K (2014) Mental stress experienced by first-year residents and expert surgeons with robotic and laparoscopic surgery interfaces. J Robot Surg 8:149–155

    Article  Google Scholar 

  29. Van der Schatte Olivier RH, Van’t Hullenaar CDP, Ruurda JP, Broeders IAMJ (2009) Ergonomics, user comfort and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 23:1365–1371

    Article  PubMed Central  PubMed  Google Scholar 

  30. Balch CM, Freischlag JA, Shanafelt TD (2009) Stress and burnout among surgeons. Arch Surg 144:371–376

    Article  PubMed  Google Scholar 

  31. Szafranski C, Kahol K, Ghaemmaghami V, Smith M, Ferrara J (2009) Distractions and surgical proficiency: an educational perspective. Am J Surg 198:804–810

    Article  PubMed  Google Scholar 

  32. Vine SJ, McGrath JS, Bright E, Dutton T, Clark J, Wilson MR (2014) Assessing visual control during simulated and live operations: gathering evidence for the content validity of simulation using eye movement metrics. Surg Endosc 28:1788–1793

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was funded by Intuitive Surgical Ltd. through their, ‘Surgical Clinical Robotics Research Grant’ program. However, Intuitive Surgical Ltd. had no involvement in the design and execution of the research, nor in the analysis or interpretation of the data presented.

Disclosures

Mr. Lee Moore, Ms. Elizabeth Waine, Dr. Mark Wilson, Mr. John McGrath, Dr. Rich Masters, and Dr. Samuel Vine have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Faculty of Applied Sciences, University of Gloucestershire, Cheltenham, UK

    Lee J. Moore

  2. College of Life and Environmental Sciences, University of Exeter, Exeter, UK

    Mark R. Wilson & Samuel J. Vine

  3. Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK

    John S. McGrath & Elizabeth Waine

  4. Institute of Human Performance, University of Hong Kong, Hong Kong, China

    Rich S. W. Masters

  5. Department of Sport and Leisure Studies, Faculty of Education, University of Waikato, Hamilton, New Zealand

    Rich S. W. Masters

Authors
  1. Lee J. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark R. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John S. McGrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Waine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rich S. W. Masters
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Samuel J. Vine
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel J. Vine.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moore, L.J., Wilson, M.R., McGrath, J.S. et al. Surgeons’ display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy. Surg Endosc 29, 2553–2560 (2015). https://doi.org/10.1007/s00464-014-3967-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3967-y

Keywords

Search

Navigation