Introduction: The development of single port RARP has introduced an entirely new robotic system that may affect human-system interactions in the operating room. These changes may affect surgeon, and surgical team, workload and performance. Therefore, we evaluated workload across surgical roles using the NASA-TLX survey to identify potential predictors of high workload for future performance improvement.
Methods: The main goal of this study was to compare the intraoperative workload and teamwork during robot-assisted radical prostatectomy using multi-port (da Vinci Xi) and single-port (da Vinci SP) robots. The self-reported workload for the surgeon and surgical team (surgical assistant, surgical technician, and circulating nurse) were all evaluated and the effects of time (learning curve) was also considered as a factor of interest in this study. The self-reported teamwork was collected from the surgeon and surgical teams.
Results: The data from 25 multi-port and 25 single-port RRPs revealed that overall, the NASA-TLX workload subscales were lower, and the teamwork subscales were higher for the multi-port RRPs compared to the single-port RRPs. There were learning effects especially for the surgeon, surgical technician, and circulating nurse through the 25 single-port RRPs. Additionally, it was revealed that the underlying reason for the significant differences between these two RRP surgical procedures could be other factors (e.g., robot design factors) in addition to the surgeon and surgical team’s experience.
Conclusions: In conclusion, single-port RARP led to higher workload subscales especially for the surgeon, surgical assistant and circulating nurse compared to multi-port RARP. Furthermore, workload as assessed by NASA-TLX, demonstrated evidence of a significant learning curve early in the development of the technique, which improved with additional experience. The sub scales that demonstrated the most significant impact included those in surgeon and surgical team temporal demand, effort, and fatigue. Future development in surgical robotics should consider the impact of workload of the surgeon and surgical team, particularly mental demand, frustration, and effort as these workload subscales were higher even after the initial 25 surgical procedures.