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Are Surgeons Working Smarter or Harder? A Systematic Review Comparing the Physical and Mental Demands of Robotic and Laparoscopic or Open Surgery

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Abstract

Background

Minimally invasive surgical techniques such as robotic surgical platforms have provided favourable outcomes for patients, but the impact on surgeons is not well described. This systematic review aims to synthesize and evaluate the physical and mental impact of robotic surgery on surgeons compared to standard laparoscopic or open surgery.

Methods

A search strategy was developed to identify peer-reviewed English articles published from inception to end of December 2019 on the following databases: MEDLINE, PubMed, PsycINFO and Embase. The articles were assessed using a modified Newcastle–Ottawa tool.

Results

Of the 6563 papers identified, 30 studies were included in the qualitative synthesis of this review. Most of the included studies presented a high risk of bias. A total of 13 and 21 different physical and mental tools, respectively, were used to examine the impact on surgeons. The most common tool used to measure physical and mental demand were surface electromyography (N = 9) and the NASA Task Load Index (NASA-TLX; N = 8), respectively. Majority of studies showed mixed results for physical (N = 10) and mental impact (N = 7). This was followed by eight and six studies favouring RS over other surgical modalities for physical and mental impact, respectively.

Conclusion

Most studies showed mixed physical and mental outcomes between the three surgical modalities. There was a high risk of bias and methodological heterogeneity. Future studies need to correlate mental and physical stress with long-term impact on the surgeons.

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References

  1. Darzi A, Munz Y (2004) The impact of minimally invasive surgical techniques. Annu Rev Med 55:223–237

    Article  CAS  Google Scholar 

  2. Wagenaar S, Nederhoed JH, Hoksbergen AWJ et al (2017) Minimally invasive, laparoscopic, and robotic-assisted techniques versus open techniques for kidney transplant recipients: a systematic review. Eur Urol 72:205–217

    Article  Google Scholar 

  3. Gershman B, Bukavina L, Chen Z et al (2018) The association of robot-assisted versus pure laparoscopic radical nephrectomy with perioperative outcomes and hospital costs. Eur Urol Focus 6:305–312

    Article  Google Scholar 

  4. Stefanidis D, Wang F, Korndorffer JR Jr et al (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24:377–382

    Article  Google Scholar 

  5. Coughlin GD, Yaxley JW, Chambers SK et al (2018) Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol 19:1051–1060

    Article  Google Scholar 

  6. Berguer R, Forkey DL, Smith WD (1999) Ergonomic problems associated with laparoscopic surgery. Surg Endosc 13:466–468

    Article  CAS  Google Scholar 

  7. Lee GI, Lee MR, Clanton T et al (2014) Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 28:456–465

    Article  Google Scholar 

  8. Dalsgaard T, Jensen MD, Hartwell D et al (2020) Robotic surgery is less physically demanding than laparoscopic surgery: paired cross sectional study. Ann Surg 271:106–113

    Article  Google Scholar 

  9. Hislop J, Tirosh O, McCormick J et al (2019) Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis. Surg Endosc 03:03

    Google Scholar 

  10. Dalager T, Sogaard K, Bech KT et al (2017) Musculoskeletal pain among surgeons performing minimally invasive surgery: a systematic review. Surg Endosc 31:516–526

    Article  Google Scholar 

  11. Abdelrahman AM, Lowndes B, Rand C et al (2017) Impact of robotic surgery versus laparoscopic surgery on surgeon musculoskeletal symptoms and workload: a systematic review and meta-analysis. Surg Endosc Other Interv Tech 31(1):S324

    Google Scholar 

  12. Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647

    Article  Google Scholar 

  13. Herzog R, Álvarez-Pasquin MJ, Díaz C et al (2013) Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 13:154

    Article  Google Scholar 

  14. van der Schatte Olivier RH, Van’t Hullenaar CD, Ruurda JP et al (2009) Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 23:1365–1371

    Article  Google Scholar 

  15. Hubert N, Gilles M, Desbrosses K et al (2013) Ergonomic assessment of the surgeon’s physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot 9:142–147

    Article  CAS  Google Scholar 

  16. Zihni AM, Ohu I, Cavallo JA et al (2014) Ergonomic analysis of robot-assisted and traditional laparoscopic procedures. Surg Endosc 28:3379–3384

    Article  Google Scholar 

  17. Sanchez A, Rodriguez O, Jara G et al (2018) Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model. J Robot Surg 12:523–527

    Article  Google Scholar 

  18. Stefanidis D, Hope WW, Scott DJ (2011) Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favored by more surgeons compared with laparoscopy. Surg Endosc 25:2141–2146

    Article  Google Scholar 

  19. Moss EL, Sarhanis P, Ind T et al (2019) Impact of obesity on surgeon ergonomics in robotic and straight-stick laparoscopic surgery. J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2019.07.009

    Article  PubMed  Google Scholar 

  20. Law KE, Lowndes BR, Kelley SR et al (2018) NASA-task load index differentiates surgical approach opportunities for improvement in colon and rectal surgery. Ann Surg. https://doi.org/10.1097/SLA.0000000000003173

    Article  PubMed  Google Scholar 

  21. Lee J, Kang SW, Jung JJ et al (2011) Multicenter study of robotic thyroidectomy: Short-term postoperative outcomes and surgeon ergonomic considerations. Ann Surg Oncol 18:2538–2547

    Article  Google Scholar 

  22. Elhage O, Challacombe B, Shortland A et al (2015) An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int 115:274–281

    Article  Google Scholar 

  23. Zihni AM, Ohu I, Cavallo JA et al (2014) FLS tasks can be used as an ergonomic discriminator between laparoscopic and robotic surgery. Surg Endosc 28:2459–2465

    Article  Google Scholar 

  24. Lawson EH, Curet MJ, Sanchez BR et al (2007) Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project. J Robot Surg 1:61–67

    Article  Google Scholar 

  25. Szeto GP, Poon JT, Law WL (2013) A comparison of surgeon’s postural muscle activity during robotic-assisted and laparoscopic rectal surgery. J Robot Surg 7:305–308

    Article  Google Scholar 

  26. Zarate Rodriguez JG, Zihni AM, Ohu I et al (2019) Ergonomic analysis of laparoscopic and robotic surgical task performance at various experience levels. Surg Endosc 33:1938–1943

    Article  Google Scholar 

  27. Mendes V, Bruyere F, Escoffre JM et al (2019) Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries. J Robot Surg. https://doi.org/10.1007/s11701-019-00933-2

    Article  PubMed  Google Scholar 

  28. Armijo PR, Huang CK, High R et al (2019) Ergonomics of minimally invasive surgery: an analysis of muscle effort and fatigue in the operating room between laparoscopic and robotic surgery. Surg Endosc 33:2323–2331

    Article  Google Scholar 

  29. Van Koughnett JA, Jayaraman S, Eagleson R et al (2009) Are there advantages to robotic-assisted surgery over laparoscopy from the surgeon’s perspective? J Robot Surg 3:79–82

    Article  Google Scholar 

  30. Tarr ME, Brancato SJ, Cunkelman JA et al (2015) Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study. J Minim Invasive Gynecol 22:234–238

    Article  Google Scholar 

  31. Marcon B, Sime WN, Guillemin F et al (2019) An ergonomic assessment of four different donor nephrectomy approaches for the surgeons and their assistants. Res Rep Urol 11:261–268

    PubMed  PubMed Central  Google Scholar 

  32. Butler KA, Kapetanakis VE, Smith BE et al (2013) Surgeon fatigue and postural stability: is robotic better than laparoscopic surgery? J Laparoendosc Adv Surg Tech A 23:343–346

    Article  Google Scholar 

  33. Moore LJ, Wilson MR, Waine E et al (2015) Robotically assisted laparoscopy benefits surgical performance under stress. J Robot Surg 9:277–284

    Article  Google Scholar 

  34. Collins SA, O’Sullivan DM, Tulikangas PK (2012) Surgeon activity in robotic versus abdominal gynecologic surgery. J Robot Surg 6:333–336

    Article  Google Scholar 

  35. Gonzalez-Sanchez M, Gonzalez-Poveda I, Mera-Velasco S et al (2017) Comparison of fatigue accumulated during and after prolonged robotic and laparoscopic surgical methods: a cross-sectional study. Surg Endosc 31:1119–1135

    Article  Google Scholar 

  36. Klein MI, Warm JS, Riley MA et al (2012) Mental workload and stress perceived by novice operators in the laparoscopic and robotic minimally invasive surgical interfaces. J Endourol 26:1089–1094

    Article  Google Scholar 

  37. Moore LJ, Wilson MR, McGrath JS et al (2015) Surgeons’ display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy. Surg Endosc 29:2553–2560

    Article  Google Scholar 

  38. Hurley AM, Kennedy PJ, O’Connor L et al (2015) SOS save our surgeons: stress levels reduced by robotic surgery. Gynecol Surg 12:197–206

    Article  Google Scholar 

  39. Passerotti CC, Franco F, Bissoli JC et al (2015) Comparison of the learning curves and frustration level in performing laparoscopic and robotic training skills by experts and novices. Int Urol Nephrol 47:1075–1084

    Article  Google Scholar 

  40. Klein MI, Mouraviev V, Craig C et al (2014) Mental stress experienced by first-year residents and expert surgeons with robotic and laparoscopic surgery interfaces. J Robot Surg 8:149–155

    Article  Google Scholar 

  41. Heemskerk J, Zandbergen HR, Keet SW et al (2014) Relax, it’s just laparoscopy! a prospective randomized trial on heart rate variability of the surgeon in robot-assisted versus conventional laparoscopic cholecystectomy. Dig Surg 31:225–232

    Article  Google Scholar 

  42. Lowndes BR, Forsyth KL, Blocker RC et al (2020) NASA-TLX Assessment of surgeon workload variation across specialties. Ann Surg 271:686–692

    Article  Google Scholar 

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Acknowledgements

We would like to thank the librarians at the University of Sydney for their time and assistance in the systematic literature search.

Funding

There are no sources of funding to declare for this current study.

Author information

Authors and Affiliations

  1. Central Clinical School, The University of Sydney, Sydney, NSW, 2050, Australia

    Laura Seohyun Park & Feiyang Pan

  2. Australia & Faculty of Medicine and Health, Surgical Outcomes Research Centre (SOuRCe), Central Clinical School, Royal Prince Alfred Hospital (RPAH), The University of Sydney, Sydney, NSW, 2050, Australia

    Daniel Steffens

  3. The University of Sydney, Sydney, NSW, 2050, Australia

    Jane Young

  4. Institute of Academic Surgery at Royal Prince Alfred Hospital (IAS RPA), Missenden Road, Camperdown, NSW, 2050, Australia

    Jonathan Hong

  5. Australia & Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, 2050, Australia

    Jonathan Hong

Authors
  1. Laura Seohyun Park
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  2. Feiyang Pan
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  4. Jane Young
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Correspondence to Jonathan Hong.

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Park, L.S., Pan, F., Steffens, D. et al. Are Surgeons Working Smarter or Harder? A Systematic Review Comparing the Physical and Mental Demands of Robotic and Laparoscopic or Open Surgery. World J Surg 45, 2066–2080 (2021). https://doi.org/10.1007/s00268-021-06055-x

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  • DOI: https://doi.org/10.1007/s00268-021-06055-x

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