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Background <p>Robotic surgical platforms offer enhanced dexterity and ergonomics, yet their impact on technical precision and surgeon cognitive workload (CWL) remains ill-defined. This study compared robotic versus laparoscopic gastrojejunal (GJ) anastomosis during gastric bypass to determine differences in technical precision and CWL.</p> Methods <p>A prospective multicentre observational study was conducted across eight tertiary centres. Experienced bariatric surgeons beyond their learning curves performed standardised GJ anastomoses using either robotic or laparoscopic platforms. Objective performance was assessed using validated tools (BOSATS, GOALS and GEARS), and six predefined precision metrics. Surgeon CWL was measured using the NASA Task Load Index (NASA-TLX). Data were analysed using a nested mixed-effects model to control for inter-surgeon variance, with subgroup stratification by case complexity.</p> Results <p>A total of 109 cases were analysed (66 laparoscopic, 43 robotic). Global objective performance scores were comparable between groups (laparoscopic 4.51 vs. robotic 4.58; <i>p</i> = 0.48). Nested analysis accounting for high inter-surgeon variance demonstrated that robotic assistance significantly reduced surgeon frustration (<i>p</i> = 0.03). Subgroup analysis revealed that the robotic platform significantly reduced overall NASA-TLX scores in both primary (<i>p</i> = 0.001) and complex revisional cases (<i>p</i> &lt; 0.0001). Task-specific precision favoured the robotic approach in primary cases, with fewer incorrect suture placements (<i>p</i> = 0.03) and missed knot throws (<i>p</i> = 0.004). Notably, the significant inverse correlation between CWL and performance observed in laparoscopy (<i>r</i> = −&#xa0;0.487, <i>p</i> = 0.001) was completely neutralized in the robotic cohort (<i>r</i> = −&#xa0;0.009, <i>p</i> = 0.96).</p> Conclusion <p>Robotic GJ anastomosis is associated with enhanced task-specific precision and a clinically meaningful reduction in CWL, particularly during complex revisional procedures. By decoupling surgeon stress from technical fidelity, the robotic platform acts as a performance stabilizer during demanding reconstructive tasks.</p> Graphical abstract <p></p>

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Robotic intracorporeal anastomosis enhances technical precision while reducing surgeon cognitive load: a prospective multicentre study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Yit J. Leang,
  • Kaleb R. Lourensz,
  • Maria K. Vanguardia,
  • Chrys S. Hensman,
  • Damien Loh,
  • Richard Chen,
  • Andrew J. Packiyanathan,
  • Joseph C. H. Kong,
  • Jacob A. Chisholm,
  • Krishna P. Epari,
  • Lilian Kow,
  • Candice D. Silverman,
  • Michael L. Talbot,
  • Jason Free,
  • Hamish Shilton,
  • Wendy A. Brown,
  • Paul R. Burton

摘要

Background

Robotic surgical platforms offer enhanced dexterity and ergonomics, yet their impact on technical precision and surgeon cognitive workload (CWL) remains ill-defined. This study compared robotic versus laparoscopic gastrojejunal (GJ) anastomosis during gastric bypass to determine differences in technical precision and CWL.

Methods

A prospective multicentre observational study was conducted across eight tertiary centres. Experienced bariatric surgeons beyond their learning curves performed standardised GJ anastomoses using either robotic or laparoscopic platforms. Objective performance was assessed using validated tools (BOSATS, GOALS and GEARS), and six predefined precision metrics. Surgeon CWL was measured using the NASA Task Load Index (NASA-TLX). Data were analysed using a nested mixed-effects model to control for inter-surgeon variance, with subgroup stratification by case complexity.

Results

A total of 109 cases were analysed (66 laparoscopic, 43 robotic). Global objective performance scores were comparable between groups (laparoscopic 4.51 vs. robotic 4.58; p = 0.48). Nested analysis accounting for high inter-surgeon variance demonstrated that robotic assistance significantly reduced surgeon frustration (p = 0.03). Subgroup analysis revealed that the robotic platform significantly reduced overall NASA-TLX scores in both primary (p = 0.001) and complex revisional cases (p < 0.0001). Task-specific precision favoured the robotic approach in primary cases, with fewer incorrect suture placements (p = 0.03) and missed knot throws (p = 0.004). Notably, the significant inverse correlation between CWL and performance observed in laparoscopy (r = − 0.487, p = 0.001) was completely neutralized in the robotic cohort (r = − 0.009, p = 0.96).

Conclusion

Robotic GJ anastomosis is associated with enhanced task-specific precision and a clinically meaningful reduction in CWL, particularly during complex revisional procedures. By decoupling surgeon stress from technical fidelity, the robotic platform acts as a performance stabilizer during demanding reconstructive tasks.

Graphical abstract