Visual, physical, and mental strain during simulated robotic surgical tasks on Hugo™ RAS and impact of microbreaks on them: a randomized controlled trial.

BACKGROUND

The use of robotic surgical consoles predisposes surgeons to visual, physical, and mental strain. While microbreaks are beneficial in laparoscopic surgery, their role in open-console robotic systems, remains unclear.

METHODS

Thirty-six surgical residents performed standardized simulated tasks on the Hugo™ RAS system. They were randomized to either an intervention group receiving a 5-min guided microbreak after 45 min of activity or a control group working continuously. Visual strain was assessed using visual fatigue questionnaire and objectively by near point of accommodation [NPA], near point of convergence [NPC], stereoacuity, visual acuity. Additionally tear film quality was assessed by Schirmer's test and tear break-up time [TBUT]. Physical strain was evaluated using the Body Part Discomfort scale and the SURG-TLX Physical domain, mental strain was assessed using heart rate variability and the SURG-TLX Mental domain. Measurements were obtained at baseline and post-task.

RESULTS

Robotic task performance resulted in significant worsening of pressure around the eyes, dryness, eye fatigue, heaviness of eyelids, blurred near and far vision, NPA, NPC, stereoacuity, Schirmer's test, and TBUT. Musculoskeletal discomfort significantly increased in the neck, shoulders, hands/wrists, and back. Microbreaks provided limited symptomatic benefit for select visual symptoms- eye dryness [p = 0.022] and eye irritation [p = 0.022]-but did not significantly influence objective ocular measures, musculoskeletal or mental strain outcomes.

CONCLUSION

Simulated robotic surgery on the Hugo™ RAS system induces substantial visual and physical strain. Although microbreaks modestly alleviate select eye symptoms, their overall ergonomic benefit seems limited. Further research is needed to develop effective strategies to protect surgeon visual and musculoskeletal health during robotic surgery.