Comparative Analysis of Subjective Workload in Laparoscopy and Open Surgery Using NASA-TLX

  • Giovanni MirandaEmail author
  • Mario Casmiro
  • Giorgio Cavassi
  • Riccardo Naspetti
  • Egidio Miranda
  • Riccardo Sacchetti
  • Emanuele Dabizzi
  • Rosario Tranchino
Conference paper
Part of the Advances in Intelligent Systems and Computing book series (AISC, volume 818)


Background: The mental resources required by laparoscopy (LS) and open (OS) surgery may be different; if this hypothesis is correct, the analysis of subjective total workload (STW) could allow to identify the causes of such differences and reduce the risk of error.

Objective: We tested the hypothesis that STW is different between LS and OS.

Methods: The NASA-TLX questionnaire was self-administered by trained physicians at the end of each procedure; STW was calculated using NASA-TLX software.

Results: Fourteen surgeons performed 66 LS and 48 OS procedures. The OS group showed a higher STW. Sub-item analysis showed higher temporal demand and frustration values in the OS group. In both groups STW was not normally distributed, showing a high (HWS) and a low (LWS) STW subgroup; the HWS within the LS group exhibited a higher mental and physical demand.

Conclusions: NASA-TLX is a valuable tool for assessing STW in the surgical setting. Higher STW was observed in the OS group, possibly related to a longer duration of such procedures and a greater experience of the “open surgeons”. These results should be viewed with caution because of potentially confounding variables; larger studies will be required to identify STW determinants among different surgical groups.


Ergonomics Laparoscopy NASA-TLX Mental workload 



Preliminary findings of this study were presented at the 14th Italian Congress of Neuroepidemiology, held in Milan, Italy, November 21–22, 2014. The authors thank Luca Vignatelli, MD, for his valuable suggestions in the reading of the data and the following surgeons who collaborated in the collection of cases: Andrea Valeri, MD, Andrea Rinnovati, MD, Bernardo Boffi, MD, Chiara Linari, MD, Silvia Nesi, MD, Alessandra Vegni, MD, Lapo Bencini, MD, Luis Jose Sanchez, MD, Marco Bernini, MD, Marco Farsi, MD, Massimo Calistri, MD, Nicola Antonacci, MD, and Silvia Aldrovandi, MD.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Giovanni Miranda
    • 1
    Email author
  • Mario Casmiro
    • 2
    • 3
  • Giorgio Cavassi
    • 1
  • Riccardo Naspetti
    • 4
  • Egidio Miranda
    • 5
  • Riccardo Sacchetti
    • 6
  • Emanuele Dabizzi
    • 7
  • Rosario Tranchino
    • 8
  1. 1.Ergonomics UnitFaentia ConsultingFaenzaItaly
  2. 2.Research & Development UnitFaentia ConsultingFaenzaItaly
  3. 3.Unit of Neurology, Ospedale per gli InfermiAUSL della RomagnaFaenzaItaly
  4. 4.Digestive EndoscopyAzienda Ospedaliero - Universitaria CareggiFlorenceItaly
  5. 5.Unit of General SurgeryOspedale del CasentinoBibbienaItaly
  6. 6.Oncologic SurgeryAzienda Ospedaliero - Universitaria CareggiFlorenceItaly
  7. 7.Digestive EndoscopyPoliclinicoModenaItaly
  8. 8.Unit of General SurgeryOspedale per gli Infermi, AUSL della RomagnaFaenzaItaly

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