Subjective workload in operating room team members during robotic hernia procedures

While robotic surgery has been dominated by a single platform in the United States for over 25 years, the introduction of new robotic systems may have an impact on subjective workload. Therefore, we aimed to establish baseline workload measurements for operating room team members using the DaVinci surgical robot during robotic hernia procedures, providing reference points for evaluating team adaptation as new robotic platforms are introduced. Within the operating room, subjective workload refers to the physical, cognitive, and temporal demands experienced during surgical procedures. We prospectively collected NASA-TLX surveys from surgeons, circulators, and scrub staff performing robotic hernia repairs between February-December 2024. Baseline demographics and prior robotic experience were collected for each participant. Surveys assessed subjective workload across six NASA-TLX domains and surgeon assessment of case complexity relative to other procedures (Easiest 1/3, Average, Hardest 1/3). Case-specific information was extracted from the electronic medical record. We used linear mixed-effects models (LMMs) to analyze role-based and complexity-related workload, which accounts for within-subject correlation from repeated measurements collected from the same individuals across different surgical cases. A total of 131 post-operative surveys were analyzed from 14 participants across 72 robotic hernia cases. Robotic OR team members reported similar baseline workload with the highest overall workload reported by circulators (mean 30.6, 95% CI 22.1-39.2), followed by scrub staff (mean 25.1, 95% CI 16.5-33.7). Surgeons experienced the lowest overall workload (mean 24.4, 95% CI 10.2-38.6), however, demonstrated a significant stepwise increase in workload with increasing case complexity (mean 11.4 to 41.5, Cohen's d = 3.41, 95% CI [2.31, 4.51], p < 0.0001), while circulators and scrub staff were unaffected. Comparisons across NASA-TLX domains showed that circulators reported significantly worse self-assessed performance (mean difference vs. surgeons: 14.97, 95% CI [8.84, 21.10], p = 0.001; vs. scrub staff: 9.60, 95% CI [4.21, 14.99], p = 0.002) and higher effort compared to other team members (mean difference vs scrub staff: 11.07, 95% CI [3.20, 18.94], p = 0.017). These findings provide one of the first role-specific benchmarks for intraoperative workload in robotic hernia surgery, representing essential reference metrics against which new robotic platforms can be evaluated. Further exploration of these role-specific challenges is needed to determine if there are opportunities to optimize workload to improve patient safety, team efficiency, and staff well-being as new platforms are adopted.