Comprehensive Assessment of Skill-related Physical and Cognitive Ergonomics Associated with Robotic and Traditional Laparoscopic Surgeries

Gyusung Lee, PhD, Mija Lee, PhD, Tameka Clanton, MS, Michael Marohn, DO

Johns Hopkins University School of Medicine, Baltimore, MD; University of Maryland School of Medicine

Introduction: We conducted the current study to investigate how physical and cognitive workloads exhibited by surgeons would differ between robotic and laparoscopic surgeries and whether any ergonomic differences would be related to surgeons’ robotic surgery skill level. To date, only a few studies have investigated the ergonomic advantages of robotic surgery. However, these studies did not investigate skill-related ergonomic differences. Our hypothesis is that the unique features in robotic surgery will demonstrably skill-related results both in substantially less physical and cognitive workload and uncompromised task performance.

Methods and Procedures: Thirteen MIS surgeons were recruited for this IRB-approved study and categorized into three groups based upon their robotic surgery experiences: laparoscopy experts with no robotic experience (n=6), novices with no or little robotic experience (n=4), and robotic experts (n=3). Each participant performed six surgical training tasks: FLS pegboard transfer, FLS circle cutting, tension running suturing, curved wire ring transfer, simulated para-esophageal hernia repair, and simulated bowel anastomosis. All participants completed these tasks using traditional laparoscopy and robotic surgery. Subjects were asked to complete each task within ten minutes. Percentage completion rates were calculated for tasks not completed within 10 minutes. Physical workload assessment was performed using surface electromyography (EMG) to measure muscular activation levels and timing from eight muscles (biceps, triceps, deltoid, trapezius, flexor carpi ulnaris, extensor digitorum, thenar compartment, and erector spinae). Cumulative muscular workload was calculated from the percentage maximum voluntary contraction (%MVC). Mental workload assessment was conducted using objective and subjective cognitive tools including the NASA-Task Load Index (TLX) and secondary time estimation.

Results: Our physical workload analysis showed that the cumulative muscular workload from the biceps (32,593 %MVC) and the flexor carpi ulnaris (60,220 %MVC) while performing robotic surgery was significantly lower than the CMW associated with laparoscopy (46,347 and 84,779 %MVC, respectively) (p<0.05). Interestingly, the cumulative muscular workload from the trapezius was significantly higher with robotic surgery (114,526 %MVC) than with laparoscopy (65,719 %MVC) (p<0.05), but this difference was only observed in laparoscopic experts and novices. NASA-TLX workload analysis showed that robotic surgery novices and experts expressed lower global workloads (26.3 and 24.4, respectively) with robotic surgery than with laparoscopy (44.1 and 40.5, respectively) while laparoscopic experts showed higher global workload with robotic surgery (45.0) than with laparoscopy (38.2) (p<0.05). Time estimation analysis showed that performing robotic surgery was substantially less demanding for robotic experts (p<0.05) when compared to other groups. Regardless of skill level, participants demonstrated faster and better performances or could complete more task components within 10 minute limit (p<0.05) with robotic surgery.

Conclusions: This study demonstrated that the physical and cognitive ergonomics associated with performing robotic surgery were significantly less challenging than those associated with laparoscopic performance. Additionally, several ergonomic components were demonstrated skill-related. Robotic experts were able to benefit the most from the ergonomic advantages offered by the robotic surgery platform with uncompromised task performance. These results emphasize the need for well-structured training programs and well-defined ergonomics guidelines to maximize the ergonomic benefits available to surgeons utilizing the robotic surgery.

Session: Podium Presentation

Program Number: S080

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