Robot-Assisted Surgery Is Stressing Surgeons

Researchers in Japan have identified objective physiological markers linked to stress in surgeons performing robot-assisted operations, findings that could help improve surgical training, operating-room design and physician well-being as robotic procedures become more common.

The observational study, published in the peer-reviewed journal Surgical Endoscopy on June 30, monitored seven experienced urologists during live robot-assisted surgeries.

Researchers from Chiba University simultaneously measured brain activity, muscle tension and heart activity while the surgeons operated.

Robot-assisted surgery has become increasingly common because it allows surgeons to perform minimally invasive procedures with greater precision.

However, surgeons still face sustained cognitive and physical demands during lengthy operations, and previous studies have largely relied on simulations or post-operation questionnaires rather than measurements taken during real procedures.

Each surgeon wore lightweight sensors that recorded brain activity using electroencephalography (EEG), muscle activity in the neck and shoulders using surface electromyography, and heart activity using electrocardiography.

After each operation, surgeons reviewed video recordings of their procedures and rated changes in their perceived stress levels on a scale from 0 to 9 using a video-stimulated recall method.

Researchers analyzed 151 stress-rated moments and found four physiological measures consistently associated with higher reported stress: increased brain activity linked to mental arousal, greater shoulder muscle tension, faster heart rate and reduced heart rate variability.

The findings suggest physiological monitoring could help identify demanding stages of robot-assisted surgery without interrupting procedures.

“Combining surgeon-reported stress annotations with multimodal physiological monitoring is feasible in RAS and may provide a basis for identifying high-demand operative moments during postoperative review,” said Professor Yoshihiro Shimomura, who led the study.

The researchers said the approach could also be used to assess operating-room systems rather than only individual surgeons.

“Beyond individual case review, surgeon-state measures could serve as an outcome for evaluating the robotic surgery work system, including console ergonomics, communication routines, workload distribution, procedure-specific difficulty, and training stage. This is the most immediate practical application of the present approach,” Shimomura said.

The team said larger studies involving more hospitals and additional surgical specialties would be needed to determine whether the measurements could support improvements in surgical technology and workplace design.

“Designing environments, equipment, and operational methods based on the results of this line of research will help manage doctors’ stress, improve surgical performance, and enhance surgeons’ own well-being. In addition, these findings could be applied to real-time stress relief interventions for surgeons, triggering briefing protocols to enhance surgical safety and supporting stress management for beginners in training using double-console systems,” Shimomura said.

The study received no external funding.

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