Amro M Abdelrahman, MBBS1, Bethany Lowndes, PhD1, Carleigh Rand, BA2, Harsh Shah, BA1, Nibras El-Sherif, MBBS1, Larry Prokop, MLS1, M. Susan Hallbeck, PhD, PE, CPE1. 1Mayo Clinic, 2St. Olaf College
INTRODUCTION: The goal of this systematic review and meta-analysis was to summarize the evidence and results on differences in surgeon musculoskeletal symptoms and workload between the robotic and laparoscopic surgeries. Despite better patient outcomes associated with minimally invasive surgery techniques compared to open; the physical and mental impact of these surgical techniques on the surgeons has not been evaluated in a systematic way, comparing robotic to laparoscopic techniques.
METHODS AND PROCEDURES: A comprehensive search of several databases from each database’s inception to June 16th, 2016, in all languages, was conducted. The databases included Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. The search strategy was designed and conducted by an experienced librarian with input from the study’s principle investigator using controlled vocabulary, supplemented with keywords, to search for comparative studies of surgeon workload for robotic versus laparoscopic surgeries. Covidence, an online systematic review platform recommended by Cochrane, has been used for screening and data extraction. Exclusion criteria were case studies, review studies, systematic reviews, consensus statements, book chapters, or non-comparative studies including a single surgical technique. The Newcastle Ottawa Scale, an instruments for assessing the quality of nonrandomized studies in meta-analyses, was applied to assess the quality of all the included studies.
RESULTS: From a pool of 1130 studies, 55 were identified as comparing surgeon musculoskeletal symptoms or workload for robotic and laparoscopic surgeries. A number of subjective and/or objective tools were used in the included comparative studies. The most common subjective tools used were SURG-TLX and NASA-TLX (n=10), and the most common objective tool used was electromyography (n=11). Overall, studies appeared to have low to moderate risk of bias on the Newcastle Ottawa Scale. Despite the general heterogeneity in outcomes reporting, robotic surgery is associated with less musculoskeletal symptoms and lower workload than laparoscopic surgery.
CONCLUSIONS: The results of this systematic review suggest that surgeon musculoskeletal symptoms and workload are lower during robotic surgery than laparoscopic surgery. Because of the high risk of bias due to methodology heterogeneity in the current literature, more consistent and homogenous methodologies are needed to measure the surgeon musculoskeletal symptoms and workload across different surgical techniques. Surgeon musculoskeletal symptoms and workload may impact patient safety and outcomes; thus, surgeon musculoskeletal symptoms and workload evaluation should be combined with patient outcomes for future prospective studies between surgical techniques.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80750
Program Number: P669
Presentation Session: Poster (Non CME)
Presentation Type: Poster