Esther Lau, BASc, MASc, MD, Nawar Alkhamesi, MD, PhD, FRCS, FRCS, FRCSEd, Christopher M Schlachta, BSc, MDCM, FRCSC, FACS. CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre and Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
Introduction: The purpose of this study was to assess the impact of robotic-assistance on mental workload and downstream cognitive performance in robot-naïve surgical trainees performing a complex laparoscopic suturing task.
Methods: Robot-naïve trainees from general surgery (GS), urology and gynecology, stratified by specialty (GS vs. non-GS) and level of training, were randomized to either laparoscopic surgery (LS) or robotic-assisted laparoscopic surgery (RALS). All subjects were shown a 5-minute video demonstrating the technique for laparoscopic, intracorporeal, running, sutured enterotomy closure. They then performed this time-limited task on an ex vivo porcine intestinal model. The RALS group received an additional 5-minute orientation to the robotic console. Subjective mental workload was measured using NASA-Task Load Index (NASA-TLX). Concentration and executive cognitive function were assessed using Psychomotor Vigilance Task (PVT) and Wisconsin Card Sorting Test (WCST), respectively. A p value of 0.05 was considered significant.
Results: Sixteen senior residents (SR; ≥PGY3) and 14 junior residents (JR; PGY1-2) completed the study. SR completed the task more often than JR (100% vs. 57%, p=0.02) with RALS having no influence. There was also no difference in mental workload (NASA-TLX) between LS and RALS. Within JR there was no difference in task-completion time comparing LS vs. RALS, however, LS was associated with impaired concentration post-task vs. pre-task (PVT reaction time 306 vs. 324 ms, p=0.03), which was not observed for RALS. In contrast, amongst SR, RALS took significantly longer than LS (10.3 vs. 14.5 minutes, p=0.02) and was associated with significantly worse performance on WCST (p<0.01).
Conclusions: Robotic-assistance, in this setting, did not provide a technical performance advantage nor impact subjective mental workload with novice users regardless of level of surgery training. Amongst junior trainees, concentration deteriorated after a complex MIS task with LS but not RALS. In contrast, amongst senior trainees, distractibility increased with RALS compared with LS. These findings may be explained as a protective effect offered by RALS to junior trainees with limited LS experience, however, a detrimental effect on senior trainees with greater LS ability and inadequate pre-study robotic training. While not conclusive, this study suggests that robotic consoles may be mentally taxing for robotic novices and consideration should be given to formal console training prior to initial clinical exposure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86624
Program Number: S087
Presentation Session: MIS Education Session
Presentation Type: Podium