title: Validation of the NASA-TLX Score in Ongoing Assessment of Mental Workload During a Laparoscopic Learning Curve in Bariatric Surgery.
abstract: BACKGROUND
  Fatigue and mental workload are directly associated with high-complexity tasks. In general, difficult tasks produce a higher mental workload, leaving little opportunity to deal with new/unexpected events and increasing the likelihood of performance errors. The laparoscopic Roux-en-Y gastric bypass (LRYGB) learning curve is considered to be one of the most difficult to complete in laparoscopic surgery. We wished to validate the National Aeronautics and Space Administration Task Load Index (NASA-TLX) in LRYGB and identify factors that could provoke a higher mental workload for surgeons during the learning curve.
  
  
  METHODS
  A single surgeon was enrolled to undertake 70 consecutive LRYGB procedures with two internal surgeons mentoring the first 35 cases. Patients were consecutive and ranked from case 35 to case 105 according to the date of the surgical procedure ("case rank"). Self-ratings of satisfaction, performance, and fatigue were measured at the end of surgery using a validated NASA-TLX questionnaire. The procedure was recorded for later viewing by two external evaluators. General data for patients and surgical variables were collected prospectively.
  
  
  RESULTS
  A moderate correlation between the NASA-TLX score, BMI, operative time, and volumes of blood drainage was observed. There was no correlation between the NASA-TLX score and duration of hospital stay or time of drain removal. BMI ≥50 kg/m(2), male sex, inexperienced first assistant, and type 2 diabetes mellitus were identified as independent predictive factors of a higher NASA-TLX score.
  
  
  CONCLUSIONS
  The NASA-TLX is a valid tool to gauge mental workload in LRYGB.
authors.affiliation: General and Digestive Surgery Department, University Hospital Reina Sofia, Avda. Menendez Pidal SN, CP:14004, Córdoba, Spain. ruizrabelo@aecirujanos.es.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Ruiz-Rabelo
authors.affiliation: General and Digestive Surgery Department, University Hospital Reina Sofia, Avda. Menendez Pidal SN, CP:14004, Córdoba, Spain. helenanr1@hotmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Navarro-Rodriguez
authors.affiliation: Cognitive Ergonomics Group, Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, C/ Campus de la Cartuja SN, CP:18075, Granada, Spain. leandro.distasi@gmail.com.
authors.forename: Leandro Luigi
authors.initials: LL
authors.lastname: Di-Stasi
authors.affiliation: General and Digestive Surgery Department, University Hospital Reina Sofia, Avda. Menendez Pidal SN, CP:14004, Córdoba, Spain. nelida.diaz.jimenez@gmail.com.
authors.forename: Nelida
authors.initials: N
authors.lastname: Diaz-Jimenez
authors.affiliation: General and Digestive Surgery Department, University Hospital Reina Sofia, Avda. Menendez Pidal SN, CP:14004, Córdoba, Spain. juancabrerabermon@gmail.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Cabrera-Bermon
authors.affiliation: General and Digestive Surgery Department, University Hospital Reina Sofia, Avda. Menendez Pidal SN, CP:14004, Córdoba, Spain. cjdi@hotmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Diaz-Iglesias
authors.affiliation: General and Digestive Surgery Department, University Hospital Reina Sofia, Avda. Menendez Pidal SN, CP:14004, Córdoba, Spain. gomezalv@hotmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gomez-Alvarez
authors.affiliation: General and Digestive Surgery Department, University Hospital Reina Sofia, Avda. Menendez Pidal SN, CP:14004, Córdoba, Spain. javibriceno@hotmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Briceño-Delgado
mesh_terms: D000328:Adult; D001288:Attention; D050110:Bariatric Surgery / Q000193:education*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016526:Workload; D055815:Young Adult
keywords: Bariatric surgery; Laparoscopic Roux-en-Y gastric bypass; Learning curve; Mental workload; NASA-TLX