Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties

Towards automatic quantification of operating table interaction in operating rooms

PURPOSE

Perioperative staff shortages are a problem in hospitals worldwide. Keeping the staff content and motivated is a challenge in the busy hospital setting of today. New operating room technologies aim to increase safety and efficiency. This causes a shift from interaction with patients to interaction with technology. Objectively measuring this shift could aid the design of supportive technological products, or optimal planning for high-tech procedures.

METHODS

35 Gynaecological procedures of three different technology levels are recorded: open- (OS), minimally invasive- (MIS) and robot-assisted (RAS) surgery. We annotate interaction between staff and the patient. An algorithm is proposed that detects interaction with the operating table from staff posture and movement. Interaction is expressed as a percentage of total working time.

RESULTS

The proposed algorithm measures operating table interactions of 70.4%, 70.3% and 30.1% during OS, MIS and RAS. Annotations yield patient interaction percentages of 37.6%, 38.3% and 24.6%. Algorithm measurements over time show operating table and patient interaction peaks at anomalous events or workflow phase transitions.

CONCLUSIONS

The annotations show less operating table and patient interactions during RAS than OS and MIS. Annotated patient interaction and measured operating table interaction show similar differences between procedures and workflow phases. The visual complexity of operating rooms complicates pose tracking, deteriorating the algorithm input quality. The proposed algorithm shows promise as a component in context-aware event- or workflow phase detection.

Experiences of robotic surgery nurses regarding technostress: a qualitative study

To qualitatively examine the experiences of robotic surgery nurses regarding technostress. It is thought that determining the impact and importance of technostress on nursing practices and roles that may be caused by robotic surgery technology, which has been widely used, will lead to the development of strategies to prevent or reduce technostress by understanding the challenges and opportunities involved in using new technology. This study was conducted in the operating theatre of a university hospital in Istanbul between May and September 2022. The sample of the study consisted of 11 operating room nurses with at least 6 months of robotic surgery nursing experience who agreed to participate in the study on the dates of the study. The data of the study were collected with a 'Personal Information Form' consisting of 14 questions and a 'Semi-Structured Interview Form' consisting of 6 questions, which were created in line with the literature and audio-recorded by in-depth interview technique. The majority of the robotic surgery nurses who participated in the study were female and received training on robotic surgery nursing. As a result of the analysis, the themes of the effect of technology on the practices of robotic surgery nurses, education and skill development, work stress and management, team dynamics and cooperation, thoughts about the future of robotic surgery, and suggestions for robotic surgery were obtained. The results of this study revealed that robotic surgery nurses working in high-tech environments are at high risk for technological stress.

Patterns and Trends in Global Nursing Robotics Research: A Bibliometric Study

Aims: The present study aimed to investigate the trends and research status of global nursing robot research. Background: The global aging population has intensified the demand for caregiving services, highlighting the need for innovative solutions like nursing robots to address caregiver shortages and enhance healthcare efficiency. A bibliometric analysis of nursing robots from 2014 to 2024 are noteworthy but limited. Methods: We searched the Web of Science database for relevant articles concerning nursing robots, published between January 1, 2014 to October 30, 2024. Data collected include: the number of publications, countries, institutions, authors, journals, reference, and keywords. CiteSpace were used to conduct the bibliometric analysis. Results: The analysis included a total of 696 publications, which were produced by 165 institutions from 66 countries and involved 243 authors. The publications exhibited a generally increasing trend with fluctuations over time. The United States of America contributed the majority of articles, with 187 publications accounting for 26.87% of the total. Griffith University from Australia led the institutions with 11 publications, representing 1.58% of the overall count. The International Journal of Social Robotics was the most prolific in publishing articles on nursing robots, with 162 publications. Through the analysis of timeline graph and burst terms, we identified technology, functionality, and impact of nursing robots as research hotspots. The application of social robots in patient care and advancements in team collaboration during robot-assisted surgery are potential emerging research directions. Conclusions: This study presents an overview of the nursing robot research landscape over the past decade. This research offer valuable insights and direction for future trends and research trajectories in the domain of nursing robots. Implications for Nursing Management: Nursing administrators can appropriately apply nursing robots to assist in improving nursing efficiency, thereby freeing up nurses' time to focus on more complex patient care.

Intraoperative teamwork and occupational stress during robot-assisted surgery: An observational study

Robot-assisted surgery (RAS) differs from traditional OR set-ups in several ways such as operation of technology and obstructed team communication that potentially affect surgical staff's stress experiences. The current study investigates the effects of key intraoperative job demands and resources on mental workload and perceived stress in RAS. We focused on the role of intraoperative teamwork as a resource that potentially reduces occupational stress. Combining standardized expert observations in the OR with healthcare providers' self-reports, the study involved two types of robot-assisted, urological interventions. The sample consisted of 73 observed surgeries and included 242 post-operative surveys on perceived stress and mental workload from surgeons and surgical nurses. Multilevel regression analyses reveal differential effects for stress and workload. Importantly, whereas better surgical teamwork was associated with lower stress, it was unrelated to workload. Our findings provide a nuanced picture of occupational stress in RAS, particularly regarding the role of intraoperative teamwork.

Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery

BACKGROUND

The utilization of robot-assisted approaches to surgery has increased significantly over the last two decades. This has introduced novel complexities into the operating room environment, requiring management of new challenges and workflow adaptation. This study aimed to analyze challenges in the surgical setup for complex upper gastrointestinal robot-assisted surgery (UGI-RAS) and identify opportunities for solutions.

METHODS

Direct observations of surgical setup processes for UGI-RAS were performed by a trained Human Factors researcher at a non-profit academic medical center in Southern California. Setup tasks were subdivided into five phases: (1) before wheels-in; (2) patient transfer and anesthesia induction; (3) patient preparation; (4) surgery preparation; and (5) robot docking. Start/end times for each phase/task were documented along with workflow disruption (FD) narratives and timestamps. Setup tasks and FDs were analyzed using descriptive statistics.

RESULTS

Twenty UGI-RAS setup procedures were observed between May-November 2023: sleeve gastrectomy +/- hiatal hernia repair (n = 9, 45.00%); para-esophageal hernia repair +/- fundoplication (n = 8, 40.00%); revision to Roux-en-Y gastric bypass (n = 2, 10.00%); and gastric band removal (n = 1, 5.00%). Frequent FDs included planning breakdowns (n = 20, 29.85%), equipment/supply management (n = 17, 25.37%), patient care coordination (n = 8, 11.94%), and equipment challenges (n = 8, 11.94%). Eleven of 20 observations were first-start cases, of which 10 experienced delayed starts.

DISCUSSION

Interventions aimed at improving workflows during UGI-RAS setup include performing pre-operative team huddles and conducting trainings aimed at team coordination and equipment challenges. These solutions could result in improved teamwork, efficiency, and communication while reducing case start delays and turnover time.

Cognitive ergonomics and robotic surgery

Cognitive ergonomics refer to mental resources and is associated with memory, sensory motor response, and perception. Cognitive workload (CWL) involves use of working memory (mental strain and effort) to complete a task. The three types of cognitive loads have been divided into intrinsic (dependent on complexity and expertise), extraneous (the presentation of tasks) and germane (the learning process) components. The effect of robotic surgery on CWL is complex because the postural, visualisation, and manipulation ergonomic benefits for the surgeon may be offset by the disadvantages associated with team separation and reduced situation awareness. Physical fatigue and workflow disruptions have a negative impact on CWL. Intraoperative CWL can be measured subjectively post hoc with the use of self-reported instruments or objectively with real-time physiological response metrics. Cognitive training can play a crucial role in the process of skill acquisition during the three stages of motor learning: from cognitive to integrative and then to autonomous. Mentorship, technical practice and watching videos are the most common traditional cognitive training methods in surgery. Cognitive training can also occur with computer-based cognitive simulation, mental rehearsal, and cognitive task analysis. Assessment of cognitive skills may offer a more effective way to differentiate robotic expertise level than automated performance (tool-based) metrics.

The stress for surgeons: exploring stress entities with the robotic senhance surgical system

Robotic surgery is on its way to revolutionizing traditional surgical procedures, offering precise and minimally invasive techniques hypothesized to shorten recovery times and improve patient outcomes. While there have been multiple publications on robotic systems' medical and procedural achievements, more emphasis should be put on the surgeon's experience, especially in comparison with laparoscopic surgery. The present report aims to systematically examine the stress impact on surgeons by comparing the robotic Senhance Surgical System (Asensus Surgical, Durham, North Carolina, U.S.A) to laparoscopic surgery. The well-established "SURG-TLX" survey is used to measure distinct stress entities. The "SURG-TLX" survey is a modified version of the NASA-TLX, validated for surgery by M. Willson. Based on a comprehensive database from six centers encompassing various disciplines and surgical procedures, our analysis indicates significantly reduced "overall stress" levels for robotic (cockpit) compared to laparoscopic surgeons. Exploring the "SURG-TLX" stress dimensions further between methods (robotic vs. laparoscopic) and surgeon position (laparoscopic, (robotic) bedside, or (robotic) cockpit) resulted in significantly more Mental (p.value < 0.015), less Physical Demands (p.value < 0.001) and less Distraction (p.value < 0.009) for robotic surgery, especially regarding the robotic cockpit surgeons. This finding suggests that robotic surgery with the Senhance Surgical System contributes to a favorable stress profile for surgeons, potentially enhancing their overall well-being and performance.

Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study

BACKGROUND

A high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals.

METHODS

This cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale.

RESULTS

A total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons.

CONCLUSIONS

The results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members' workload.

Neurophysiological Assessment of An Innovative Maritime Safety System in Terms of Ship Operators' Mental Workload, Stress, and Attention in the Full Mission Bridge Simulator

The current industrial environment relies heavily on maritime transportation. Despite the continuous technological advances for the development of innovative safety software and hardware systems, there is a consistent gap in the scientific literature regarding the objective evaluation of the performance of maritime operators. The human factor is profoundly affected by changes in human performance or psychological state. The difficulty lies in the fact that the technology, tools, and protocols for investigating human performance are not fully mature or suitable for experimental investigation. The present research aims to integrate these two concepts by (i) objectively characterizing the psychological state of mariners, i.e., mental workload, stress, and attention, through their electroencephalographic (EEG) signal analysis, and (ii) validating an innovative safety framework countermeasure, defined as Human Risk-Informed Design (HURID), through the aforementioned neurophysiological approach. The proposed study involved 26 mariners within a high-fidelity bridge simulator while encountering collision risk in congested waters with and without the HURID. Subjective, behavioral, and neurophysiological data, i.e., EEG, were collected throughout the experimental activities. The results showed that the participants experienced a statistically significant higher mental workload and stress while performing the maritime activities without the HURID, while their attention level was statistically lower compared to the condition in which they performed the experiments with the HURID (all p < 0.05). Therefore, the presented study confirmed the effectiveness of the HURID during maritime operations in critical scenarios and led the way to extend the neurophysiological evaluation of the HFs of maritime operators during the performance of critical and/or standard shipboard tasks.