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Assessment of surgeon workload using the NASA-TLX during the early introduction of robot-assisted total knee
Tatsuya Kubo1, Tsuneari Takahashi2, Yuji Kaneda3,4
1Department of Orthopaedic Surgery, Shin-Oyama City Hospital, Oyama, Japan.
Background:
Robot-assisted total knee arthroplasty (RA-TKA) improves accuracy, but surgeon workload during early adoption is poorly studied. We quantified workload using the NASA Task Load Index (NASA-TLX) and examined its relation to operative efficiency.
Methods:
Fifty consecutive RA-TKA procedures were performed by one surgeon. After each case, workload was assessed with the NASA-TLX. Outcomes were changes in NASA-TLX scores, operative time learning curves, and perioperative safety. Analyses included segmented regression, CUSUM, and correlation tests.
Results:
Fifty knees (mean age 73 years, BMI 27) were included. Mean operative time was 97 min. Four complications occurred within 30 days, with no system failures. NASA-TLX scores declined significantly with case number (ρ = -0.54, p < 0.001), stabilizing after ∼8 cases. Operative time showed a breakpoint at 9 cases. Subscales improved earlier for mental demand, effort, temporal demand, and frustration, while performance stabilized later (∼19 cases). NASA-TLX correlated with operative time (r = 0.62, p < 0.001).
Conclusion:
Surgeon workload and operative efficiency improved in parallel, stabilizing after the first 8-10 RA-TKA cases. NASA-TLX is a practical tool for monitoring workload during robotic adoption and may guide training strategies in medium-volume institutions.
