Ergonomic Assessment of the Mental Workload Confronted by Surgeons during Laparoscopic Surgery

Abstract

Although the mental workload confronted by laparoscopic surgeons is rather high, there is presently no reliable, established method for evaluating this workload. In the present study, four evaluation indices of eye movement metrics were applied to evaluate surgeons’ mental workload. Correlations between these indices and National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores were also explored. Sixteen participants were recruited to complete four laparoscopic procedures. Eye movement was recorded during the tasks, and NASA-TLX scales were also introduced for subjective evaluation. The data were analyzed using R 3.3.2. Significant differences in the mental workload of each task were observed. Statistically significant correlations between mean pupil diameter change and NASA-TLX scores were also observed. The correlation coefficients were 0.763, 0.675, 0.405, and 0.547, and the P values correspondingly were 0.001, 0.004, 0.12, and 0.028, respectively. The results clarify that the mental workload of laparoscopic surgeons is dependent on the specific demands of the operation. Appropriate objective physiological indices can be used to identify the mental workload state of the surgeon.

Save our surgeons (SOS) – an explorative comparison of surgeons’ muscular and cardiovascular demands, posture, perceived workload and discomfort during robotic vs. laparoscopic surgery

“…Based on previous studies it has been postulated that the mental workload for laparoscopic surgeons is rather high [ 36 ]. The decrease in physical demands in one of the six dimensions of perceived workload is in line with the objective muscular demand outcomes described above.…”

Subjective and Objective Quantification of the Effect of Distraction on Physician’s Workload and Performance During Simulated Laparoscopic Surgery

“…Eye-tracking assessments of pupil dilation are a useful proxy for mental workload during laparoscopic surgery [14]. However, because pupil sizes vary between individuals, direct comparisons of the ensuing data can be hampered by variance.…”

The Measurement of Cognitive Workload in Surgery Using Pupil Metrics: A Systematic Review and Narrative Analysis

“…54 Similarly within surgery, MPDC increased with greater workload during laparoscopic surgery, peak pupil size increased with task difficulty, pupil size increased with distractions, and TEPR and percentage change in pupil size represented participant expertise supporting existing literature. 23,35,42,49,51 Reduced blink rates were described among surgeons who report a higher workload during tasks of increased complexity in keeping with other fields such as flight simulation. 22,50,55,56 Reduced fixation rates and greater fixation durations are reported among expert surgeons.…”

“…52 There has therefore been an emphasis to identify pupillary size change during surgical procedures as a marker of mental workload. Zhang et al 49 studied 16 laparoscopic surgeons and medical students with previous laparoscopic surgery experience in a simulated setting to find that mean pupil diameter change (MPDC) demonstrated a significantly strong correlation with NASA-TLX scores. However, other parameters including saccadic velocity, mean blink rate, and fixation time rate were also analyzed although these did not reflect CWL as accurately as MPDC.…”