Automation in Surgery: The Impact of Navigated-Control Assistance on the Performance, Workload and Situation Awareness of Surgeons

The present study investigates performance consequences of a new approach of automated support for surgeons. “Navigated-Control” (NC) represents an advancement of image-guided navigation that does not only support the surgeon in navigating through a patient's anatomy, but also can stop the surgical device if it comes too close to risk structures which need to be protected to ensure patient safety. It is explored, how NC affects different aspects of surgical outcome, workload and stress, and situation awareness. Fourteen advanced students of medicine performed a simulated Mastoidectomy with and without NC support. The results reveal that NC support can reduce both, the risk of intra-operative injuries, as well as the physiological stress level of surgeons. However, “cost effects” emerged with respect to subjective workload, and a reduced spare capacity compared to unsupported surgeries. These latter effects do not seem to be related to the principle of NC but technical constraints of current implementations.