Sleep, Stress, and Experience Supersede Vibrotactile Haptic Feedback as Contributors to Workload During Robotic Surgical Skill Acquisition

2020

Miscellaneous

hi

Introduction: How does the absence of haptic feedback in robotic surgery affect surgical skill acquisition? This study is a prospective single-blinded randomized controlled trial examining the effect of haptic feedback of instrument vibrations during simulation-based training on resident workload and performance during both simulated and live operating room Robotic-Assisted Sleeve Gastrectomy (RASG), which provides surgical trainees with significant robotic console experience. Methods: Twelve surgical residents (seven PGY-3, five PGY-7) were randomized to receive either haptic feedback or no haptic feedback during a proctored simulation session that took place before the first operative cases of a bariatric service rotation. Workload measures including pre- and post-procedure short-form State-Trait Anxiety Inventory (STAI) and NASA Task Load Index (TLX) were recorded in both the simulated and OR settings. Multivariable linear regression with backward selection was performed to examine potential associations between workload measures and factors including haptic feedback, PGY-level, case volume, robotic operative time, and hours of sleep. Results: Subjects performed a total of 60 simulated bariatric surgical procedures and 79 live patient RASGs. During the simulation session, PGY-7 status was associated with a 12.8% decrease in TLX score (p<0.001); one additional hour of sleep yielded a 4.43% decrease in TLX score (p=0.004); one additional point in pre-procedure STAI score yielded a 1.87% increase in TLX score (p=0.003); and a one percent increase in operative time yielded a 0.12% increase in TLX score (p<0.001). During live OR cases, one additional RASG case experience during the rotation was associated with a 1.1% decrease in TLX score (p=0.01); one additional point in pre-procedure STAI score was associated with a 2.64% increase in TLX score (p<0.001); and a one percent increase in robotic operative time was associated with a 0.17% increase in TLX score (p<0.001). Haptic feedback did not significantly affect workload in either setting. No factors had a significant association with pre- to post-procedural change in STAI score. Conclusion: Providing vibrotactile haptic feedback during training neither increased nor decreased resident workload during simulated or live robotic surgical cases, possibly because the utility of the feedback counterbalances the additional processing required. In contrast, PGY-level, baseline stress, operative time, sleep, and case experience all contribute to workload in robotic surgery; these factors can be potential targets of educational intervention. Finally, TLX may be a more robust workload measurement tool than STAI in the context of robotic surgery.

@misc{Gomez20-SAGESEA-Sleep,
  title = {Sleep, Stress, and Experience Supersede Vibrotactile Haptic Feedback as Contributors to Workload During Robotic Surgical Skill Acquisition},
  author = {Gomez, Ernest D. and Husin, Haliza Mat and Dumon, Kristoffel R. and Williams, Noel N. and Kuchenbecker, Katherine J.},
  howpublished = {Extended abstract presented as an ePoster at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)},
  address = {Cleveland, USA},
  month = aug,
  year = {2020},
  doi = {},
  month_numeric = {8}
}