OBJECTIVE The aim of this study was to investigate the effect of intraoperative targeted stretching micro breaks (TSMBs) on the experienced pain and fatigue, physical functions, and mental focus of surgeons. BACKGROUND Surgeons are routinely subject to mental and physical stresses through the course of their work in the operating room. One of the factors most contributory to the shortening of a surgeon's career is work-related pain and its effects on patient safety and personal relationships. METHODS Surgeons and operating room staff from 4 medical centers rated pain/fatigue, physical, and mental performance using validated scales during 2 operative days: 1 day without implementing TSMB, the other including standardized (1.5 to 2 minutes) guided TSMB at appropriate 20 to 40-minute intervals throughout each case. Case type and duration were recorded as were surgeon pain data before and after each procedure and at the end of the surgical day. Individual body part pre/postdiscomfort difference was modeled, controlling for clinical center. Random coefficient mixed models accounted for surgeon variability. RESULTS Sixty-six participants (69% men, 31% women; mean 47 years) completed 193 "non-TSMB" and 148 "TSMB" procedures. Forty-seven percent of surgeons were concerned that musculoskeletal pain may shorten their career. TSMB improved surgeon postprocedure pain scores in the neck, lower back, shoulders, upper back, wrists/hands, knees, and ankles. Operative duration did not differ (P> 0.05). Improved pain scores with TSMB were statistically equivalent (P > 0.05) for laparoscopic and open procedures. Surgeons perceived improvements in physical performance (57%) and mental focus (38%); 87% of respondents planned to continue TSMB. CONCLUSIONS Many surgeons are concerned about career-ending or limiting musculoskeletal pain. Intraoperative TSMB may represent a practical, effective means to reduce surgeon pain, enhance performance, and increase mental focus without extending operative time.

Objective: The goal of this systematic literature review is to investigate the relationship between indirect physiological measurements and direct measures of situation awareness (SA). Background: Across different environments and tasks, assessments of SA are often performed using techniques designed specifically to directly measure SA, such as SAGAT, SPAM, and/or SART. However, research suggests that indirect physiological sensing methods may also be capable of predicting SA. Currently, it is unclear which particular physiological approaches are sensitive to changes in SA. Method: Seven databases were searched using the PRISMA reporting guidelines. Eligibility criteria included human-subject experiments that used at least one direct SA assessment technique, as well as at least one physiological measurement. Information extracted from each article was the physiological metric(s), the direct SA measurement(s), the correlation between these two metrics, and the experimental task(s). All studies underwent a quality assessment. Results: Twenty-five articles were included in this review. Eye tracking techniques were the most commonly used physiological measures, and correlations between conscious aspects of eye movement measures and direct SA scores were observed. Evidence for cardiovascular predictors of SA were mixed. EEG studies were too few to form strong conclusions, but were consistently positive. Conclusion: Further investigation is needed to methodically collect more relevant data and comprehensively model the relationships between a wider range of physiological measurements and direct assessments of SA. Application: This review will guide researchers and practitioners in methods to indirectly assess SA with sensors and highlight opportunities for future research on wearables and SA.

Recent literature has demonstrated ergonomic risk to surgeons in the operating room. One method used in other industries to mitigate these ergonomic risks is the incorporation of microbreaks. Thus, intraoperative microbreaks with exercises in a non-crossover design were studied. Fifty-six attending surgeons from 4 Medical Centers volunteered first in a day of their regular surgeries and then second day where there were microbreaks with exercises that could be performed in the sterile field, answering questions after each case, without significantly increasing the duration of their surgeries. Surgeons self-reported improvement or no change in their mental focus (88%) and physical performance (100%) for the surgical day incorporating microbreaks with exercises. Discomfort in the shoulders was significantly reduced while distractions and flow impact was minimal. Eighty-seven percent of the surgeons wanted to incorporate the microbreaks with exercises into their OR routine. Intraoperative microbreaks with exercises may be a way to mitigate work-related musculoskeletal fatigue, pain and injury.

Objective: The aim of this study is to assess the relationship between eye-tracking measures and perceived workload in robotic surgical tasks. Background: Robotic techniques provide improved dexterity, stereoscopic vision, and ergonomic control system over laparoscopic surgery, but the complexity of the interfaces and operations may pose new challenges to surgeons and compromise patient safety. Limited studies have objectively quantified workload and its impact on performance in robotic surgery. Although not yet implemented in robotic surgery, minimally intrusive and continuous eye-tracking metrics have been shown to be sensitive to changes in workload in other domains. Methods: Eight surgical trainees participated in 15 robotic skills simulation sessions. In each session, participants performed up to 12 simulated exercises. Correlation and mixed-effects analyses were conducted to explore the relationships between eye-tracking metrics and perceived workload. Machine learning classifiers were used to determine the sensitivity of differentiating between low and high workload with eye-tracking features. Results: Gaze entropy increased as perceived workload increased, with a correlation of .51. Pupil diameter and gaze entropy distinguished differences in workload between task difficulty levels, and both metrics increased as task level difficulty increased. The classification model using eye-tracking features achieved an accuracy of 84.7% in predicting workload levels. Conclusion: Eye-tracking measures can detect perceived workload during robotic tasks. They can potentially be used to identify task contributors to high workload and provide measures for robotic surgery training. Application: Workload assessment can be used for real-time monitoring of workload in robotic surgical training and provide assessments for performance and learning.