title: Automation in surgery: the impact of navigated-control assistance on performance, workload, situation awareness, and acquisition of surgical skills.
abstract: OBJECTIVE
  Human performance consequences of a new technology of image-guided navigation (IGN) support for surgeons are investigated.
  
  
  BACKGROUND
  Navigated control (NC) represents an advancement of IGN technology. In contrast to currently available pointer-based systems, it represents a higher degree of automation that supports processes not only of information analysis and integration but also of intraoperative decision making.
  
  
  METHODS
  In the first experiment, 14 surgical novices performed a simulated mastoidectomy with and without NC support. Effects of provision of the system were analyzed with respect to different measures of surgical performance and outcome, workload, and situation awareness. In the second experiment, 21 advanced medical students were trained to perform a mastoidectomy by practicing it either with or without NC support. It was investigated to what extent the provision of the system during practice would affect the acquisition of surgical skills.
  
  
  RESULTS
  The results reveal that NC support can reduce both the risk of intraoperative injuries and complications as well as the physiological effort of surgeons. "Cost effects" compared to a conventional (i.e., not supported) surgery emerged with respect to the time needed for the surgery, increased subjective workload, reduced spare capacity, and a reduced level of situation awareness. However, no significant effects on processes of skill acquisition were found.
  
  
  CONCLUSIONS
  NC systems can contribute to improved patient safety. Most of the cost effects seem to be related not to the basic principle of NC but to its current technological implementation.
  
  
  CONCLUSIONS
  The results have consequences for the design and clinical use of automated navigation support.
authors.affiliation: Berlin Institute of Technology, Institute of Psychology and Ergonomics, Marchstrasse 12, Sekr. F 7, D-10587 Berlin, Germany. dietrich.manzey@tu-berlin.de
authors.forename: Dietrich
authors.initials: D
authors.lastname: Manzey
authors.forename: Maria
authors.initials: M
authors.lastname: Luz
authors.forename: Stefan
authors.initials: S
authors.lastname: Mueller
authors.forename: Andreas
authors.initials: A
authors.lastname: Dietz
authors.forename: Juergen
authors.initials: J
authors.lastname: Meixensberger
authors.forename: Gero
authors.initials: G
authors.lastname: Strauss
mesh_terms: D000328:Adult; D001364:Awareness; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008953:Models, Anatomic; D025321:Surgery, Computer-Assisted; D013647:Task Performance and Analysis; D016526:Workload; D055815:Young Adult