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Impact of robotic assistance on mental workload and cognitive performance of surgical trainees performing a complex minimally invasive suturing task

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Few studies have investigated the potential impact of robotic assistance on cognitive ergonomics during advanced minimally invasive surgery. The purpose of this study was to assess the impact of robotic assistance on mental workload and downstream cognitive performance in surgical trainees.

Methods

Robot-naïve trainees from general surgery, urology and gynaecology, stratified by specialty and level of training, were randomised to either laparoscopic surgery (LS) or robotic-assisted laparoscopic surgery (RALS) and performed a time-limited, complex laparoscopic suturing task after watching a 5-min instructional video. The RALS group received an additional 5-min orientation to the robotic console. Subjective mental workload was measured using NASA Task Load Index. Concentration and executive cognitive function were assessed using Psychomotor Vigilance Task (PVT) and Wisconsin Card Sorting Test (WCST), respectively. A p value of 0.05 was considered significant.

Results

Sixteen senior residents (SR; ≥ PGY3) and 14 junior residents (JR; PGY1-2) completed the study. There was no difference in mental workload between LS and RALS. Within JR there was no difference in task completion time comparing LS versus RALS; however, LS was associated with impaired concentration post-task versus pre-task (PVT reaction time 306 versus 324 ms, p = 0.03), which was not observed for RALS. In contrast, amongst SR, RALS took significantly longer than LS (10.3 vs. 14.5 min, p = 0.02) and was associated with significantly worse performance on WCST (p < 0.01).

Conclusions

Robotic assistance, in this setting, did not provide a technical performance advantage nor impact subjective mental workload with novice users regardless of level of surgery training. We observed a protective effect on cognitive performance offered by RALS to junior trainees with limited LS experience, yet a detrimental effect on senior trainees with greater LS ability and inadequate pre-study robotic training, suggesting that robotic consoles may be mentally taxing for robotic novices and consideration should be given to formal console training prior to initial clinical exposure.

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Funding

This study was funded by Schulich School of Medicine and Dentistry.

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Authors and Affiliations

  1. CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre, London, Canada

    Esther Lau, Nawar A. Alkhamesi & Christopher M. Schlachta

  2. Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada

    Esther Lau, Nawar A. Alkhamesi & Christopher M. Schlachta

Authors
  1. Esther Lau
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  2. Nawar A. Alkhamesi
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  3. Christopher M. Schlachta
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Corresponding author

Correspondence to Esther Lau.

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Disclosures

Dr. Schlachta has no proprietary interest in the technologies studied, but has received honoraria from Ethicon (advisory, education support), Minogue Medical (proctoring), Stryker (speaking), Novadaq (advisory) and Verb (advisory). Drs. Lau and Alkhamesi have no conflicts of interest or financial ties to disclose.

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Lau, E., Alkhamesi, N.A. & Schlachta, C.M. Impact of robotic assistance on mental workload and cognitive performance of surgical trainees performing a complex minimally invasive suturing task. Surg Endosc 34, 2551–2559 (2020). https://doi.org/10.1007/s00464-019-07038-9

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  • DOI: https://doi.org/10.1007/s00464-019-07038-9

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