title: Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries.
abstract: BACKGROUND
  We conducted this study to investigate how physical and cognitive ergonomic workloads would differ between robotic and laparoscopic surgeries and whether any ergonomic differences would be related to surgeons' robotic surgery skill level. Our hypothesis is that the unique features in robotic surgery will demonstrate skill-related results both in substantially less physical and cognitive workload and uncompromised task performance.
  
  
  METHODS
  Thirteen MIS surgeons were recruited for this institutional review board-approved study and divided into three groups based on their robotic surgery experiences: laparoscopy experts with no robotic experience, novices with no or little robotic experience, and robotic experts. Each participant performed six surgical training tasks using traditional laparoscopy and robotic surgery. Physical workload was assessed by using surface electromyography from eight muscles (biceps, triceps, deltoid, trapezius, flexor carpi ulnaris, extensor digitorum, thenar compartment, and erector spinae). Mental workload assessment was conducted using the NASA-TLX.
  
  
  RESULTS
  The cumulative muscular workload (CMW) from the biceps and the flexor carpi ulnaris with robotic surgery was significantly lower than with laparoscopy (p < 0.05). Interestingly, the CMW from the trapezius was significantly higher with robotic surgery than with laparoscopy (p < 0.05), but this difference was only observed in laparoscopic experts (LEs) and robotic surgery novices. NASA-TLX analysis showed that both robotic surgery novices and experts expressed lower global workloads with robotic surgery than with laparoscopy, whereas LEs showed higher global workload with robotic surgery (p > 0.05). Robotic surgery experts and novices had significantly higher performance scores with robotic surgery than with laparoscopy (p < 0.05).
  
  
  CONCLUSIONS
  This study demonstrated that the physical and cognitive ergonomics with robotic surgery were significantly less challenging. Additionally, several ergonomic components were skill-related. Robotic experts could benefit the most from the ergonomic advantages in robotic surgery. These results emphasize the need for well-structured training and well-defined ergonomics guidelines to maximize the benefits utilizing the robotic surgery.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock Building, Room 1210, Baltimore, MD, 21287, USA, gyusunglee@jhu.edu.
authors.forename: Gyusung I
authors.initials: GI
authors.lastname: Lee
authors.forename: Mija R
authors.initials: MR
authors.lastname: Lee
authors.forename: Tameka
authors.initials: T
authors.lastname: Clanton
authors.forename: Tamera
authors.initials: T
authors.lastname: Clanton
authors.forename: Erica
authors.initials: E
authors.lastname: Sutton
authors.forename: Adrian E
authors.initials: AE
authors.lastname: Park
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marohn
mesh_terms: D003071:Cognition / Q000502:physiology*; D004576:Electromyography; D004867:Equipment Design; D006804:Ergonomics / Q000592:standards*; D005542:Forearm / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000592:standards; D018482:Muscle, Skeletal / Q000502:physiology*; D012371:Robotics / Q000592:standards*; D016526:Workload