Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties

doi:10.1016/j.amjsurg.2023.06.010

. 2023 Sep;226(3):365-370.

doi: 10.1016/j.amjsurg.2023.06.010. Epub 2023 Jun 10.

Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties

Jennifer Zamudio¹, Jeffrey Woodward², Falisha F Kanji³, Jennifer T Anger⁴, Ken Catchpole⁵, Tara N Cohen⁶

Affiliations

¹ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: Jennifer.Zamudio@cshs.org.
² Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA. Electronic address: woodwaje@musc.edu.
³ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: Falisha.Kanji@cshs.org.
⁴ Department of Urology, University of California San Diego, La Jolla, CA, 92037, USA. Electronic address: janger@health.ucsd.edu.
⁵ Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA. Electronic address: catchpol@musc.edu.
⁶ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: Tara.Cohen@cshs.org.

PMID: 37330385
PMCID: PMC11234353
DOI: 10.1016/j.amjsurg.2023.06.010

Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties

Jennifer Zamudio et al. Am J Surg. 2023 Sep.

. 2023 Sep;226(3):365-370.

doi: 10.1016/j.amjsurg.2023.06.010. Epub 2023 Jun 10.

Authors

Jennifer Zamudio¹, Jeffrey Woodward², Falisha F Kanji³, Jennifer T Anger⁴, Ken Catchpole⁵, Tara N Cohen⁶

Affiliations

¹ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: Jennifer.Zamudio@cshs.org.
² Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA. Electronic address: woodwaje@musc.edu.
³ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: Falisha.Kanji@cshs.org.
⁴ Department of Urology, University of California San Diego, La Jolla, CA, 92037, USA. Electronic address: janger@health.ucsd.edu.
⁵ Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA. Electronic address: catchpol@musc.edu.
⁶ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: Tara.Cohen@cshs.org.

PMID: 37330385
PMCID: PMC11234353
DOI: 10.1016/j.amjsurg.2023.06.010

Abstract

Background: Current approaches to assessing workload in robotic-assisted surgery (RAS) focus on surgeons and lack real-world data. Understanding how workload varies by role and specialty aids in identifying effective ways to optimize workload.

Methods: SURG-TLX surveys with six domains of workload were administered to surgical staff at three sites. Staff reported workload perceptions for each domain on a 20-point Likert scale, and aggregate scores were determined per participant.

Results: 188 questionnaires were obtained across 90 RAS procedures. Significantly higher aggregate scores were reported for gynecology (Mdn = 30.00) (p = 0.034) and urology (Mdn = 36.50) (p = 0.006) than for general (Mdn = 25.00). Surgeons reported significantly higher scores for task complexity (Mdn = 8.00) than both technicians (Mdn = 5.00) (p = 0.007), and nurses (Mdn = 5.00).

Conclusions: Staff reported significantly higher workload during urology and gynecology procedures, and experienced significant differences in domain workload by role and specialty, elucidating the need for tailored workload interventions.

Keywords: Cognitive ergonomics; NASA-TLX; Robotic-assisted surgery; Workload.

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Conflict of interest statement

Declaration of competing interest Dr. Cohen is the Secretary for the Society of Surgical Ergonomics and Dr. Catchpole has received honorarium from mBeta Healthcare, participates in a DSMB and has a leadership role in HFTH. Remaining authors report no conflicts of interest.

Figures

**Fig. 1.**
The SURG-TLX questionnaire administered to participants.

**Fig. 2.**
A plot of the relationship between aggregate TLX scores and operative duration, highlighting those exceeding a threshold of 50 or higher.

**Fig. 3.**
Median SURG-TLX workload scores by surgical role and specialty, broken down by the six domains on a scale of 0–20. Significant pairwise comparisons (p < 0.05) are marked with an asterisk (*).

See this image and copyright information in PMC

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References

1. Celik SS, Koken ZO, Canda AE, Esen T. Experiences of perioperative nurses with robotic-assisted surgery: a systematic review of qualitative studies. J Robot Surg. Dec 21 2022. 10.1007/s11701-022-01511-9. - DOI - PubMed
1. Moore LJ, Wilson MR, McGrath JS, Waine E, Masters RS, Vine SJ. Surgeons’ display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy. Surg Endosc. Sep 2015;29(9):2553–2560. 10.1007/s00464-014-3967-y. - DOI - PubMed
1. Khorgami Z, Li WT, Jackson TN, Howard CA, Sclabas GM. The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample. Surg Endosc. Jul 2019;33(7):2217–2221. 10.1007/s00464-018-6507-3. - DOI - PubMed
1. Cofran L, Cohen T, Alfred M, et al. Barriers to safety and efficiency in robotic surgery docking. Surg Endosc. Jan 2022;36(1):206–215. 10.1007/s00464-020-08258-0. - DOI - PMC - PubMed
1. Kanji F, Cohen T, Alfred M, et al. Room size influences flow in robotic-assisted surgery. Int J Environ Res Publ Health. Jul 28 2021;18(15). 10.3390/ijerph18157984. - DOI - PMC - PubMed

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[1] Celik SS, Koken ZO, Canda AE, Esen T. Experiences of perioperative nurses with robotic-assisted surgery: a systematic review of qualitative studies. J Robot Surg. Dec 21 2022. 10.1007/s11701-022-01511-9. - DOI - PubMed

[2] Celik SS, Koken ZO, Canda AE, Esen T. Experiences of perioperative nurses with robotic-assisted surgery: a systematic review of qualitative studies. J Robot Surg. Dec 21 2022. 10.1007/s11701-022-01511-9. - DOI - PubMed

[3] Moore LJ, Wilson MR, McGrath JS, Waine E, Masters RS, Vine SJ. Surgeons’ display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy. Surg Endosc. Sep 2015;29(9):2553–2560. 10.1007/s00464-014-3967-y. - DOI - PubMed

[4] Moore LJ, Wilson MR, McGrath JS, Waine E, Masters RS, Vine SJ. Surgeons’ display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy. Surg Endosc. Sep 2015;29(9):2553–2560. 10.1007/s00464-014-3967-y. - DOI - PubMed

[5] Khorgami Z, Li WT, Jackson TN, Howard CA, Sclabas GM. The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample. Surg Endosc. Jul 2019;33(7):2217–2221. 10.1007/s00464-018-6507-3. - DOI - PubMed

[6] Khorgami Z, Li WT, Jackson TN, Howard CA, Sclabas GM. The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample. Surg Endosc. Jul 2019;33(7):2217–2221. 10.1007/s00464-018-6507-3. - DOI - PubMed

[7] Cofran L, Cohen T, Alfred M, et al. Barriers to safety and efficiency in robotic surgery docking. Surg Endosc. Jan 2022;36(1):206–215. 10.1007/s00464-020-08258-0. - DOI - PMC - PubMed

[8] Cofran L, Cohen T, Alfred M, et al. Barriers to safety and efficiency in robotic surgery docking. Surg Endosc. Jan 2022;36(1):206–215. 10.1007/s00464-020-08258-0. - DOI - PMC - PubMed

[9] Kanji F, Cohen T, Alfred M, et al. Room size influences flow in robotic-assisted surgery. Int J Environ Res Publ Health. Jul 28 2021;18(15). 10.3390/ijerph18157984. - DOI - PMC - PubMed

[10] Kanji F, Cohen T, Alfred M, et al. Room size influences flow in robotic-assisted surgery. Int J Environ Res Publ Health. Jul 28 2021;18(15). 10.3390/ijerph18157984. - DOI - PMC - PubMed

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Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties

Affiliations

Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties

Authors

Affiliations

Abstract

Conflict of interest statement

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References

MeSH terms

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