Background

Evaluate and compare surgeon muscle activity and cognitive stress during bariatric surgeries laparoscopic and robotic: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

Methods

Two surgeons performed a combined total of 42 surgeries, 18 laparoscopic and 24 robotic. Muscle activity was measured by surface electromyography (EMG) and evaluation of cognitive stress pre/post procedure was done by the NASA Task Load Index (NASA-TLX). Investigator self-reported measures of the fatigue, pain/discomfort and general patient demographics were collected. Surgeons ranked their workload using the NASA-TLX self-assessment tool.

Results

Combining surgeries from both surgeons, laparoscopic surgeries required greater work on all domains compared to robotic, with the exception of mental demand. The mean overall workload score for laparoscopic cases was 39 [95% CI 28, 50 p<.001] compared to robotic cases mean score 14 [95% CI 11, 18, p<0.001]. The EMG data muscle activity was higher using a robotic technique compared to laparoscopic [medium to large effect size with homogenous 95% CI] for both SG and RYGB cases for predominately the lumbar erector spinae groups with exception in activity for the upper trapezius muscle group in which the laparoscopic cases had increase change [95% CI p=.007].

Conclusions

The NASA-TLX data indicate robotic procedures have less overall workload and physical demands on the surgeon whereas the EMG data suggests muscle activity trends were higher for robotic cases for lumbar erector spinae muscle groups and for laparoscopic cases an increase change for the upper trapezius muscle groups was noted. Comparative operative times were observed for robotic cases.