Top

World Journal of Surgery

Published in:

01-07-2021 | Scientific Review

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

Authors: Laura Seohyun Park, Feiyang Pan, Daniel Steffens, Jane Young, Jonathan Hong

Published in: World Journal of Surgery | Issue 7/2021

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.

Available only for authorised users

Darzi A, Munz Y (2004) The impact of minimally invasive surgical techniques. Annu Rev Med 55:223–237CrossRef

Wagenaar S, Nederhoed JH, Hoksbergen AWJ et al (2017) Minimally invasive, laparoscopic, and robotic-assisted techniques versus open techniques for kidney transplant recipients: a systematic review. Eur Urol 72:205–217CrossRef

Gershman B, Bukavina L, Chen Z et al (2018) The association of robot-assisted versus pure laparoscopic radical nephrectomy with perioperative outcomes and hospital costs. Eur Urol Focus 6:305–312CrossRef

Stefanidis D, Wang F, Korndorffer JR Jr et al (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24:377–382CrossRef

Coughlin GD, Yaxley JW, Chambers SK et al (2018) Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol 19:1051–1060CrossRef

Berguer R, Forkey DL, Smith WD (1999) Ergonomic problems associated with laparoscopic surgery. Surg Endosc 13:466–468CrossRef

Lee GI, Lee MR, Clanton T et al (2014) Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 28:456–465CrossRef

Dalsgaard T, Jensen MD, Hartwell D et al (2020) Robotic surgery is less physically demanding than laparoscopic surgery: paired cross sectional study. Ann Surg 271:106–113CrossRef

Hislop J, Tirosh O, McCormick J et al (2019) Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis. Surg Endosc 03:03

10.

Dalager T, Sogaard K, Bech KT et al (2017) Musculoskeletal pain among surgeons performing minimally invasive surgery: a systematic review. Surg Endosc 31:516–526CrossRef

11.

Abdelrahman AM, Lowndes B, Rand C et al (2017) Impact of robotic surgery versus laparoscopic surgery on surgeon musculoskeletal symptoms and workload: a systematic review and meta-analysis. Surg Endosc Other Interv Tech 31(1):S324

12.

Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647CrossRef

13.

Herzog R, Álvarez-Pasquin MJ, Díaz C et al (2013) Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 13:154CrossRef

14.

van der Schatte Olivier RH, Van’t Hullenaar CD, Ruurda JP et al (2009) Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 23:1365–1371CrossRef

15.

Hubert N, Gilles M, Desbrosses K et al (2013) Ergonomic assessment of the surgeon’s physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot 9:142–147CrossRef

16.

Zihni AM, Ohu I, Cavallo JA et al (2014) Ergonomic analysis of robot-assisted and traditional laparoscopic procedures. Surg Endosc 28:3379–3384CrossRef

17.

Sanchez A, Rodriguez O, Jara G et al (2018) Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model. J Robot Surg 12:523–527CrossRef

18.

Stefanidis D, Hope WW, Scott DJ (2011) Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favored by more surgeons compared with laparoscopy. Surg Endosc 25:2141–2146CrossRef

19.

Moss EL, Sarhanis P, Ind T et al (2019) Impact of obesity on surgeon ergonomics in robotic and straight-stick laparoscopic surgery. J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2019.07.009CrossRefPubMed

20.

Law KE, Lowndes BR, Kelley SR et al (2018) NASA-task load index differentiates surgical approach opportunities for improvement in colon and rectal surgery. Ann Surg. https://doi.org/10.1097/SLA.0000000000003173CrossRefPubMed

21.

Lee J, Kang SW, Jung JJ et al (2011) Multicenter study of robotic thyroidectomy: Short-term postoperative outcomes and surgeon ergonomic considerations. Ann Surg Oncol 18:2538–2547CrossRef

22.

Elhage O, Challacombe B, Shortland A et al (2015) An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int 115:274–281CrossRef

23.

Zihni AM, Ohu I, Cavallo JA et al (2014) FLS tasks can be used as an ergonomic discriminator between laparoscopic and robotic surgery. Surg Endosc 28:2459–2465CrossRef

24.

Lawson EH, Curet MJ, Sanchez BR et al (2007) Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project. J Robot Surg 1:61–67CrossRef

25.

Szeto GP, Poon JT, Law WL (2013) A comparison of surgeon’s postural muscle activity during robotic-assisted and laparoscopic rectal surgery. J Robot Surg 7:305–308CrossRef

26.

Zarate Rodriguez JG, Zihni AM, Ohu I et al (2019) Ergonomic analysis of laparoscopic and robotic surgical task performance at various experience levels. Surg Endosc 33:1938–1943CrossRef

27.

Mendes V, Bruyere F, Escoffre JM et al (2019) Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries. J Robot Surg. https://doi.org/10.1007/s11701-019-00933-2CrossRefPubMed

28.

Armijo PR, Huang CK, High R et al (2019) Ergonomics of minimally invasive surgery: an analysis of muscle effort and fatigue in the operating room between laparoscopic and robotic surgery. Surg Endosc 33:2323–2331CrossRef

29.

Van Koughnett JA, Jayaraman S, Eagleson R et al (2009) Are there advantages to robotic-assisted surgery over laparoscopy from the surgeon’s perspective? J Robot Surg 3:79–82CrossRef

30.

Tarr ME, Brancato SJ, Cunkelman JA et al (2015) Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study. J Minim Invasive Gynecol 22:234–238CrossRef

31.

Marcon B, Sime WN, Guillemin F et al (2019) An ergonomic assessment of four different donor nephrectomy approaches for the surgeons and their assistants. Res Rep Urol 11:261–268PubMedPubMedCentral

32.

Butler KA, Kapetanakis VE, Smith BE et al (2013) Surgeon fatigue and postural stability: is robotic better than laparoscopic surgery? J Laparoendosc Adv Surg Tech A 23:343–346CrossRef

33.

Moore LJ, Wilson MR, Waine E et al (2015) Robotically assisted laparoscopy benefits surgical performance under stress. J Robot Surg 9:277–284CrossRef

34.

Collins SA, O’Sullivan DM, Tulikangas PK (2012) Surgeon activity in robotic versus abdominal gynecologic surgery. J Robot Surg 6:333–336CrossRef

35.

Gonzalez-Sanchez M, Gonzalez-Poveda I, Mera-Velasco S et al (2017) Comparison of fatigue accumulated during and after prolonged robotic and laparoscopic surgical methods: a cross-sectional study. Surg Endosc 31:1119–1135CrossRef

36.

Klein MI, Warm JS, Riley MA et al (2012) Mental workload and stress perceived by novice operators in the laparoscopic and robotic minimally invasive surgical interfaces. J Endourol 26:1089–1094CrossRef

37.

Moore LJ, Wilson MR, McGrath JS et al (2015) Surgeons’ display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy. Surg Endosc 29:2553–2560CrossRef

38.

Hurley AM, Kennedy PJ, O’Connor L et al (2015) SOS save our surgeons: stress levels reduced by robotic surgery. Gynecol Surg 12:197–206CrossRef

39.

Passerotti CC, Franco F, Bissoli JC et al (2015) Comparison of the learning curves and frustration level in performing laparoscopic and robotic training skills by experts and novices. Int Urol Nephrol 47:1075–1084CrossRef

40.

Klein MI, Mouraviev V, Craig C et al (2014) Mental stress experienced by first-year residents and expert surgeons with robotic and laparoscopic surgery interfaces. J Robot Surg 8:149–155CrossRef

41.

Heemskerk J, Zandbergen HR, Keet SW et al (2014) Relax, it’s just laparoscopy! a prospective randomized trial on heart rate variability of the surgeon in robot-assisted versus conventional laparoscopic cholecystectomy. Dig Surg 31:225–232CrossRef

42.

Lowndes BR, Forsyth KL, Blocker RC et al (2020) NASA-TLX Assessment of surgeon workload variation across specialties. Ann Surg 271:686–692CrossRef

Title: Are Surgeons Working Smarter or Harder? A Systematic Review Comparing the Physical and Mental Demands of Robotic and Laparoscopic or Open Surgery
Authors: Laura Seohyun Park
Feiyang Pan
Daniel Steffens
Jane Young
Jonathan Hong
Publication date: 01-07-2021
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-021-06055-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2021

Effectiveness of Pain Control of Local Anaesthetic Wound Infusion Following Elective Midline Laparotomy: A Randomized Trial

The Relationship Between Co-morbidity, Screen-Detection and Outcome in Patients Undergoing Resection for Colorectal Cancer

Patient-Reported Quality of Life Following Laparotomy in a Resource-Limited Setting

Impact of Bypass Flow Assessment on Long-Term Outcomes in Patients with Chronic Limb-Threatening Ischemia

The World Journal of Surgery Welcomes Dr. Tamara Fitzgerald to the Editorial Board

The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases