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

Abstract

Purpose Conventional laparoscopic surgery (CLS) imposes an increased risk of work-related musculoskeletal disorders. Technical innovations, such as robotic-assisted laparoscopic surgery (RALS), may provide ergonomic benefits. We compare the surgeon`s work-related demands of CLS vs RALS for benign hysterectomies. Methods Five specialists (3 females, 2 males) each performed four RALS and four CLS as part of their daily clinical routine. During the surgical procedures, muscular demands were assessed by bipolar surface electromyograms of the descendent trapezius, extensor digitorum and flexor carpi radialis muscles as well as cardio-vascular demands by electrocardiography, and neck, arm and torso posture by gravimetrical position sensors. Additionally, the subjects rated their level of perceived workload (NASA TLX questionnaire with 6 dimension) and musculoskeletal discomfort (11-point Likert-scale, 0–10). Results Muscular demands of the trapezius and flexor carpi radialis muscles were lower with RALS but extensor digitorum demands increased. Cardiovascular demands were about 9 heart beats per minute (bpm) lower for RALS compared to CLS with a rather low median level for both surgical techniques (RALS = 84 bpm; CLS 90 bpm). The posture changed in RALS with an increase in neck and torso flexion, and a reduction in abduction and anteversion position of the right arm. The perceived workload was lower in the physical demands dimension but higher in the mental demands dimension during RALS. Subjective musculoskeletal discomfort was rare during both surgical techniques. Conclusions This explorative study identified several potential ergonomic benefits related to RALS which now can be verified by studies using hypothesis testing designs. However, potential effects on muscular demands in the lower arm extensor muscles also have to be addressed in such studies.

Influence of Intraoperative Active and Passive Breaks in Simulated Minimally Invasive Procedures on Surgeons’ Perceived Discomfort, Performance, and Workload

“…The overall workload (NASA-TLX) among the surgeons in this study (47.6) corresponds very well (47.5) to that from the study of Krämer et al [55], and is close to those of the studies of Thurston et al [56] and Haney et al [57] (i.e., 40.6 and 50.4, respectively). We may interpret the current study to have reached a similar moderate overall workload as the three previous studies [55][56][57].…”

“…The overall workload (NASA-TLX) among the surgeons in this study (47.6) corresponds very well (47.5) to that from the study of Krämer et al [55], and is close to those of the studies of Thurston et al [56] and Haney et al [57] (i.e., 40.6 and 50.4, respectively). We may interpret the current study to have reached a similar moderate overall workload as the three previous studies [55][56][57]. The pattern of the six workload dimensions strongly agreed with a previous study in which 40 surgeons were exposed to a simulated laparoscopic that lasted about 26 min [57] and reported the lowest mean value for frustration (40.0) and the highest mean value for effort (51.7) as dimensions of perceived workload.…”

“…The pattern of the six workload dimensions strongly agreed with a previous study in which 40 surgeons were exposed to a simulated laparoscopic that lasted about 26 min [57] and reported the lowest mean value for frustration (40.0) and the highest mean value for effort (51.7) as dimensions of perceived workload. However, two other studies showed a different pattern, with performance (25.8) as the dimension with the lowest and mental demand (50.3) as the dimension with the highest mean value [56] or temporal demand (20.0) as the dimension with the lowest and performance (90.0) as the dimension with the highest mean value [55]. These variations across studies may be due to the fact that simulations [57] have a different perceived workload exposure pattern than real laparoscopies [55,56].…”

“…However, two other studies showed a different pattern, with performance (25.8) as the dimension with the lowest and mental demand (50.3) as the dimension with the highest mean value [56] or temporal demand (20.0) as the dimension with the lowest and performance (90.0) as the dimension with the highest mean value [55]. These variations across studies may be due to the fact that simulations [57] have a different perceived workload exposure pattern than real laparoscopies [55,56]. The reason for this is that different work system factors may influence the perception of the different workload dimensions, such as team coordination, task content, availability of medical tools, and work station design [38,58].…”

Design and evaluation of a smart passive dynamic arm support for robotic-assisted laparoscopic surgery

“…While this study serves as a good indicator of the design’s functionality, it is still uncertain how the arm support improves the experience of surgeons within the operating room. Further research, incorporating practicing surgeons as participants, is needed to determine the clinical utility and impact of the arm support on behavior (e.g., clutching of the handle vs instruments), surgery outcomes and ergonomics [ 15 ]. Secondly the trial times for the short marble sorting task are not representative of the extended durations of surgical operations that can last for hours.…”