Training improves laparoscopic tasks performance and decreases operator workload as measured using the NASA-TLX score

Jesse Hu, FRCS, MRCS, MBBS, Jirong Lu, MRCS, MBBS, Wee Boon Tan, FRCS, MRCS, MBBS, Davide Lomanto, MD, Rome, PhD, Rome, FAMS, General, Sur. NUHS


It has been postulated that increased operator workload during task performance may increase fatigue and increase in errors. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a validated tool for self-assessment for workload. Our study aims to assess the relationship of workload and performance of novices in simulated laparoscopic tasks of different complexity levels before and after training.


47 medical students without prior laparoscopic experience were recruited in a randomized controlled trial comparing effects of utilizing different laparoscopic cameras during training on test scores. Participants were tested on three standard tasks (ring transfer, precision cutting and intracorporeal suturing in increasing complexity) based on the Fundamentals of Laparoscopic Surgery (FLS) curriculum. Following a period of training and rest, participants were tested again. Test scores were computed from time taken and time penalties for precision errors. Test scores and NASA-TLX scores were recorded pre and post training and analyzed using paired t-tests. One way repeated measures ANOVA was used to analyze differences in NASA-TLX scores between the 3 tasks.


NASA-TLX score was lowest with ring transfer and highest with intracorporeal suturing. This was statistically significant in both pre-training (p <0.001) and post-training (p < 0.001) NASA-TLX scores, mirroring the changes in test scores for the 3 tasks. Workload scores decreased significantly after training for all 3 tasks (ring transfer = 2.93, p<0.001, precision cutting = 3.74, p<0.001, intracorporeal suturing = 2.98, p<0.001).


NASA-TLX score is an accurate reflection of the complexity of simulated laparoscopic tasks in the FLS curriculum. This also correlates with the relationship of test scores between the 3 tasks. Simulation training improves both performance score and workload score across the tasks.


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