Abstract
Introduction
Total hip arthroplasty (THA) is a physically demanding procedure where the surgeon is subject to fatigue with increased energy expenditure comparable to exercise[1]. Robotic technologies have been introduced into operating rooms to assist surgeons with ergonomically challenging tasks and to reduce overall physical stress and fatigue[2]. Greater exposure to robotic assisted training may create efficiencies that may reduce energy expenditure[3]. The purpose of this study was to assess surgeon energy expenditure during THA and perceived mental and physical demand.
Methods
12 THAs (6 cadavers) randomized by BMI were performed by two surgeons with different robotic assisted experience. Surgeon 1 (S1) had performed over 20 robotic assisted THAs on live patients and Surgeon 2 (S2) had training on 1 cadaver with no patient experience. For each cadaver, laterality was randomized and manual total hip arthroplasty (MTHA) was performed first on one hip and robotic assisted total hip arthroplasty (RATHA) on the contralateral hip. A biometric shirt collected surgeon data on caloric energy expenditure (CEE) throughout acetabular reaming (AR) and acetabular implantation (AI) for each THA procedure. Surgeon mental and physical demand was assessed after each surgery. Scores were reported from 1–10, with 10 indicating high demand. A paired sample t-test was performed between MTHA and RATHA within each surgeon group with a confidence interval of (α =0.05).
Results
Each surgeon demonstrated greater CEE during MTHA, Figure 1. Surgeon CEE during MTHA was greater for S1(100±28.1 cals) compared to RATHA(83.5±0.34 cals), with no significant difference (p>0.05, p=0.49). Energy expenditure was greater for S2 during MTHA(83.5±16.3 cals) compared to RATHA(75.3±0.71 cals) with no significance (p>0.05, p=0.68). RATHA resulted in a decrease in average CEE for each surgeon with a reduction of 16.5% for S1 and 9.8 % for S2. Surgeon task time during MTHA was greater for S1(14.7±3.2 mins) compared to RATHA(12.3±4.93 mins), with no significance (p>0.05, p=0.46). Average task time was greater for S2 during MTHA(10.0±2.65 mins) compared to RATHA(8.7±2.89 mins) with no significant differences (p>0.05, p=0.66). Average mental and physical demand was less for RATHA compared to MTHA, Figure 2. Average physical demand reported during AR for MTHA(5.5±1.2) was greater than RATHA(4.3±2.0, p=0.08). Average physical demand was greater for AI for MTHA(6±1.3) than RATHA(3.7±2.1, p=0.29). Average mental demand was significantly greater during AR for MTHA(5.7±1.03) when compared to RATHA(3.2±1.5, p=0.007). Average mental demand was greater during AI for MTHA(6.2±1.2) than RATHA(2.3±1.5, p=0.051).
Conclusion
Regardless of prior surgical experience, both surgeons had reduced caloric expenditure when performing RATHA as compared to MTHA. For the surgeon with more RATHA experience, there was a greater percent reduction in caloric expenditure between surgical interventions. Both surgeons had similar percent reductions in time for RATHA compared to MTHA. Each surgeon noted increased mental and physical demand during MTHA. The trends suggest RATHA may reduce surgeon energy expenditure and time to perform acetabular reaming and implant insertion for THA. The pilot data suggests that there may be a relationship between energy expenditure and surgeon experience. This could be explored in future studies with a larger surgeon population.
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