CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre, London, Canada.
Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada.
Surg Endosc. 2020 Jun;34(6):2551-2559. doi: 10.1007/s00464-019-07038-9. Epub 2019 Sep 3.
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.
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.
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).
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.
很少有研究调查机器人辅助对高级微创手术中认知工效学的潜在影响。本研究的目的是评估机器人辅助对手术培训生的心理工作量和下游认知表现的影响。
按专业和培训水平分层，将来自普通外科、泌尿科和妇科的机器人新手培训生随机分为腹腔镜手术（LS）或机器人辅助腹腔镜手术（RALS）组，并在观看 5 分钟教学视频后进行限时、复杂的腹腔镜缝合任务。RALS 组接受了额外的 5 分钟机器人控制台介绍。使用 NASA 任务负荷指数（NASA Task Load Index）测量主观心理工作量。使用精神运动警觉任务（Psychomotor Vigilance Task，PVT）和威斯康星卡片分类测试（Wisconsin Card Sorting Test，WCST）分别评估注意力和执行认知功能。p 值为 0.05 被认为具有统计学意义。
16 名高级住院医师（SR；≥PGY3）和 14 名初级住院医师（JR；PGY1-2）完成了这项研究。LS 和 RALS 之间的心理工作量没有差异。在 JR 中，与 LS 相比，RALS 并没有在任务完成时间上有所不同；然而，LS 与任务后注意力受损有关（PVT 反应时间 306 毫秒对 324 毫秒，p=0.03），而 RALS 则没有观察到这种情况。相比之下，在 SR 中，RALS 比 LS 花费的时间明显更长（10.3 分钟对 14.5 分钟，p=0.02），并且在 WCST 上的表现明显更差（p<0.01）。
在这种情况下，机器人辅助并没有为新手用户提供技术性能优势，也没有影响主观心理工作量，无论手术培训水平如何。我们观察到，RALS 对腹腔镜经验有限的初级培训生的认知表现有保护作用，但对腹腔镜能力较强且缺乏术前机器人培训的高级培训生有不利影响，这表明机器人控制台对机器人新手来说可能在心理上具有挑战性，因此应该在首次临床接触前考虑进行正式的控制台培训。
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