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

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.

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

“…In fact, MIS offers a shared view of the surgical field and gives the opportunity to the entire team to understand the procedure and monitor the operation progress, but it needs the establishment of a new interpersonal routine [ 107 ]. Laparoscopy is burdened by the physical stress of the surgical team, whereas robotic surgery offers a less physically demanding approach, but introduces a console creating a physical distance of the surgeon from the team, mediating communication through a microphone [ 108 , 109 ]. In this context and maybe more in an emergency scenario, a team of well-trained people is the key factor for a successful robotic program [ 110 ] and should represent the standard also in emergency MIS.…”

Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study

“…Although the results of some studies showed that the workload in laparoscopic surgery was higher than that in open surgery, the difference was not statistically significant (Yu et al 2016 ; Law et al 2020 ). A recent systematic review (2021) showed varied physical and mental outcomes among robotic, laparoscopic, and open surgical techniques due to methodological differences (Park et al 2021 ). However, the high workload in the open surgery technique in the present study can be related to the complexity and long duration of the open surgeries.…”

Using the National Aeronautics Space Administration Task Load Index (NASA-TLX) in surgery: Considerations for use “in the wild”

“…The disruption of verbal and non-verbal cues causes teams to figure out novel solutions to navigate around these new challenges and are documented in the literature as having the ability to cause frustration for surgeons if verbal acknowledgement is not made (Catchpole et al, 2019). Although physical workload has been cited as lower in robotic surgery compared to traditional laparoscopic or open-surgery methods in surgeons (Law et al, 2020), most studies show mixed outcomes in relation to physical and mental demands, likely due to varying methodologies to assess intraoperative workload (Park et al, 2021). In order to continue evaluating the challenges associated with organizations adopting robotic-assisted surgery, such as identifying variations of cognitive demands between different surgical roles (e.g., circulating nurses, scrub technicians.…”