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Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF
Published on: October 17, 2025
National Aeronautics and Space Administration-Task Load Index for minimally invasive surgeries from multiple
Ajay J Sivakumar1, Kharishma P Nair1, C Vaishnavi2
1Department of General and GI Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
Background:
Minimally invasive surgery (MIS) has become an essential component of modern surgical practice due to improved patient outcomes. However, these procedures impose significant cognitive and physical demands on surgeons, which remain inadequately quantified. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a validated subjective tool used to assess workload during complex tasks, including surgery.
Aim:
The aim of this study was to evaluate intra-operative surgeon workload during minimally invasive procedures across multiple surgical departments in a tertiary healthcare centre using NASA-TLX.
Patients And Methods:
This prospective observational study included surgeons performing elective minimally invasive procedures over a 3-month period at a tertiary care hospital. A total of 200 procedures performed by 27 surgeons across multiple departments were analysed. Emergency procedures, conversions to open surgery, combined procedures and abandoned surgeries were excluded. Surgeons completed the NASA-TLX questionnaire immediately after each procedure, assessing mental demand, physical demand, temporal demand, performance, effort and frustration. Workload scores were compared across procedure types and surgeon experience levels using appropriate statistical analyses, and effect sizes (η²) were calculated.
Results:
NASA-TLX scores demonstrated a moderate overall workload, with higher mental and physical demand. Significant differences were observed across procedures in mental demand ( P = 0.013, η² =0.07), physical demand ( P = 0.022, η² =0.06), temporal demand ( P < 0.001, η² =0.11) and frustration ( P < 0.001, η² =0.21). The mean global NASA-TLX score was 5.77 ± 1.3. Laparoscopic gastrointestinal and cholecystectomy procedures demonstrated higher workload scores. Surgeons with < 5 years' experience reported greater temporal demand, while senior surgeons demonstrated higher mental demand, effort and frustration.
Conclusion:
Surgeon workload during MIS varies with procedure type and experience level. NASA-TLX is a practical and effective tool for assessing intra-operative workload and may help optimise surgical training, ergonomics and operative planning.
