• Juan Francisco Ruiz-Rabelo, Elena Navarro-Rodriguez, Leandro Luigi Di-Stasi, Nelida Diaz-Jimenez, Juan Cabrera-Bermon, Carlos Diaz-Iglesias, Manuel Gomez-Alvarez, and Javier Briceño-Delgado.
• General and Digestive Surgery Department, University Hospital Reina Sofia, Avda. Menendez Pidal SN, CP:14004, Córdoba, Spain. ruizrabelo@aecirujanos.es.
• Obes Surg. 2015 Dec 1; 25 (12): 2451-6.

BackgroundFatigue and mental workload are directly associated with high-complexity tasks. In general, difficult tasks produce a higher mental workload, leaving little opportunity to deal with new/unexpected events and increasing the likelihood of performance errors. The laparoscopic Roux-en-Y gastric bypass (LRYGB) learning curve is considered to be one of the most difficult to complete in laparoscopic surgery. We wished to validate the National Aeronautics and Space Administration Task Load Index (NASA-TLX) in LRYGB and identify factors that could provoke a higher mental workload for surgeons during the learning curve.MethodsA single surgeon was enrolled to undertake 70 consecutive LRYGB procedures with two internal surgeons mentoring the first 35 cases. Patients were consecutive and ranked from case 35 to case 105 according to the date of the surgical procedure ("case rank"). Self-ratings of satisfaction, performance, and fatigue were measured at the end of surgery using a validated NASA-TLX questionnaire. The procedure was recorded for later viewing by two external evaluators. General data for patients and surgical variables were collected prospectively.ResultsA moderate correlation between the NASA-TLX score, BMI, operative time, and volumes of blood drainage was observed. There was no correlation between the NASA-TLX score and duration of hospital stay or time of drain removal. BMI ≥50 kg/m(2), male sex, inexperienced first assistant, and type 2 diabetes mellitus were identified as independent predictive factors of a higher NASA-TLX score.ConclusionsThe NASA-TLX is a valid tool to gauge mental workload in LRYGB.

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