Robotically Assisted Spine Surgery Reduces Mental Workload

Introduction
Pedicle screw placement during spine fusion surgery is physically and mentally demanding for the surgeon. Given the significant mental demand required for placing pedicle screws, surgeons can become physically and mentally fatigued, which has implications on both patient safety and surgeon well-being. The purpose of this study is to assess the cognitive load of surgeons placing pedicle screws using robotic-assisted navigation compared to CT and fluoroscopic assisted placement. We hypothesized that the cognitive load would be reduced for surgeons placing screws using robotic-assisted navigation.
Aims/Objectives
The primary aim was to determine the mental workload of surgeons following either robotic or non-robotic surgery.
Methods
A prospective trial was performed to compare the cognitive workload of surgeons performing single-level, minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using robotic, CT, or fluoroscopic navigation. Surgeon self-reported cognitive load associated with percutaneous pedicle screw placement was measured using a validated task load index (TLX) developed by the North American Space Association (NASA). Five specific tasks associated with pedicle screw placement were assessed independently, including (1) Screw Planning, (2) Calibrating Robot/Obtaining Imaging/Registration, (3) Pedicle Cannulation, (4) Screw Placement, and (5) Overall Case. Patient demographics and surgical characteristics were also obtained and reviewed. Unpaired t-tests were performed to compare mental workload scores in the robotic-assisted and fluoroscopic groups.
Results
Three surgeons and eleven patients have been enrolled to date, with 9 patients having surveys completed for analysis. 6 patients were enrolled into the robotic navigation group, 2 were enrolled into the fluoroscopic group, and 1 to the CT-guided navigation group. There were no demographic differences between groups with an overall mean age of 61.311.9 years and BMI 29.25.0. Cognitive workload was significantly less when using robotic-assisted navigation. This included decreased workload for screw planning, pedicle cannulation, screw placement, and the overall case (Figure 1). There were no differences in mental workload for calibration, registration, or image acquisition. Additionally, there were multiple differences in the TLX subdomains for each task (Figure 1).

Conclusions
This preliminary study showed significant reductions in mental workload for robotically assisted pedicle screw placement compared to fluoroscopic and CT-navigation techniques. While multiple studies have assessed accuracy with regards to pedicle screw placement, this is the first study to assess mental workload.