Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 May;27(5):1318-1326.
doi: 10.1245/s10434-019-08159-0. Epub 2020 Jan 8.

Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM

M Susan Hallbeck  1   2   3 , Katherine E Law  4   5 , Bethany R Lowndes  4   6 , Anna R Linden  4 , Melissa Morrow  4   5 , Renaldo C Blocker  4   5 , Stephen M Cain  7 , Amy C Degnim  8 , Tina J Hieken  8 , James W Jakub  8 , Jennifer M Racz  8 , David R Farley  8 , Heidi Nelson  8 , Judy C Boughey  8
Affiliations
Observational Study

Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM

M Susan Hallbeck et al. Ann Surg Oncol. 2020 May.

Abstract

Background: Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures.

Methods: From May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed.

Results: Procedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p < 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02).

Conclusion: Nipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons' left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Average NASA-TLX scores according to NSM and SSM procedures. *p < 0.05 or statistically significantly different NASA-TLX scores by procedure (NSM vs. SSM) for the subscales for physical demand and perceived effort
Fig. 2
Fig. 2
Average NASA-TLX scores by incision type for NSM procedures. *p < 0.05 or statistically significant difference between inframammary and breast-splitting approaches for NSM for the 4 NASA-TLX subscales
See this image and copyright information in PMC

References

    1. Hart SG, Staveland LE. Development of NASA-TLX (Task Load Index): results of empirical and theoretical research. Adv Psychol. 1988;52:139–183. doi: 10.1016/S0166-4115(08)62386-9. - DOI
    1. Hart SG. NASA-task load index (NASA-TLX): 20 years later. In: Proceedings of the human factors and ergonomics society annual meeting. Los Angeles, CA: Sage Publications; 2006. p. 904–8.
    1. Yurko YY, Scerbo MW, Prabhu AS, Acker CE, Stefanidis D. Higher mental workload is associated with poorer laparoscopic performance as measured by the NASA-TLX tool. Simul Healthc. 2010;5:267–271. doi: 10.1097/SIH.0b013e3181e3f329. - DOI - PubMed
    1. Dulan G, Rege RV, Hogg DC, et al. Proficiency-based training for robotic surgery: construct validity, workload, and expert levels for nine inanimate exercises. Surg Endosc. 2012;26:1516–1521. doi: 10.1007/s00464-011-2102-6. - DOI - PubMed
    1. Stefanidis D, Wang F, Korndorffer JR, Jr, Dunne JB, Scott DJ. Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc. 2010;24:377–382. doi: 10.1007/s00464-009-0578-0. - DOI - PubMed

Publication types

MeSH terms