title: The impact of environmental noise on robot-assisted laparoscopic surgical performance.
abstract: BACKGROUND
  An operating room is a noisy environment. How noise affects performance during robotic surgery remains unknown. We investigated whether noise during training with the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA) would affect the performance of simple operative tasks by the surgeon.
  
  
  METHODS
  Twelve medical students performed 3 inanimate operative tasks (bimanual carrying, suture tying, and mesh alignment) on the da Vinci Surgical System with or without the presence of noise. Prerecorded noise from an actual operating room was used. The kinematics of the robotic surgical instrument tips and the muscle activation patterns of the subjects were evaluated.
  
  
  RESULTS
  We found noise effects for all 3 tasks with increases in the time to task completion (23%; P=.046), the total distance traveled (8%; P=.011) of the surgical instrument tips, and the muscle activation volume (87%; P=.015) with the presence of noise. We confirmed that the mesh alignment task was the most difficult task with the greatest time to task completion and the greatest muscle activation volume, whereas the suture tying task and the bimanual carrying could be considered the intermediate and the least difficult task, respectively. The noise effects were significantly greater while performing more difficult tasks.
  
  
  CONCLUSIONS
  Our findings demonstrated that noise degraded robotic surgical performance; however, the impact of noise on robotic surgery will depend on the level of difficulty of the task. Subsequent research is required to identify how different types of noise, such as random or rhythmic sounds, affect the performance of operative tasks using robots such as the da Vinci.
authors.affiliation: Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE 68198-5110, USA. kcsiu@unmc.edu
authors.forename: Ka-Chun
authors.initials: KC
authors.lastname: Siu
authors.forename: Irene H
authors.initials: IH
authors.lastname: Suh
authors.forename: Mukul
authors.initials: M
authors.lastname: Mukherjee
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
authors.forename: Nick
authors.initials: N
authors.lastname: Stergiou
mesh_terms: D000328:Adult; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D009622:Noise; D012371:Robotics; D013647:Task Performance and Analysis; D055815:Young Adult