Surgeon workload in supervised robotic colorectal surgery: a surgical task load index study

Robot-assisted colorectal surgery (RAS) is increasingly adopted; however, surgeon workload during supervised training and its determinants remain unclear.

We conducted a single-center study combining a prospective surgical task load index (Surgical-TLX) assessment and a retrospective cohort analysis (October 2023-August 2025). Junior surgeons were defined as non-Japan Society for Endoscopic Surgery (JSES)-certified surgeons who had < 10 robot-assisted colorectal cases as the primary operator and were within 8 years after graduation. All junior cases were performed under direct supervision by JSES-certified surgeons throughout the procedure. The primary outcome was Surgical-TLX workload (six domains). Secondary outcomes included operative time, console time, blood loss, Clavien-Dindo complications, length of stay, and pathological findings.

Surgical-TLX was assessed in 72 cases by 10 surgeons. Compared with JSES-certified surgeons, junior surgeons had higher mental, temporal, task complexity, and situational awareness workload. In multivariable models, high temporal burden was associated with advanced tumor factors (T ≥ 3 and N-positive disease). Operative and console times were longer for junior surgeons, whereas blood loss, postoperative complications (Clavien-Dindo ≥ 2 or ≥ 3), length of stay, and pathological outcomes were comparable.

Under structured supervision, RAS can be implemented safely for junior surgeons despite higher perceived workload. Surgical-TLX may help visualize cognitive burden and inform graded autonomy and supervisory strategies, particularly for advanced tumors.