Observational studyAnnals of surgical oncology2020
Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM.
Observational study in Annals of surgical oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Feasibility and outcomes of single-incision robotic nipple-sparing mastectomy: a systematic review and meta-analysis.Journal of robotic surgery · 2026Pooled it
- The Use of Wearable Systems for Assessing Work-Related Risks Related to the Musculoskeletal System-A Systematic Review.International journal of environmental research and public health · 2024Pooled it
- A Prospective, Multicenter Randomized Controlled Trial (RCT) of the da Vinci SPAnnals of surgical oncology · 2026Trial
- Assessment of a Passive Exoskeleton for Neck and Lower Back Support: A Task Study on Muscle Activity and User Perceived Exertion.Sensors (Basel, Switzerland) · 2026Article
- Use of an Intraoperative Head, Neck, and Back Support Exoskeleton on Surgeons' Pain and Posture.Annals of surgery · 2026Article
- Comparative outcomes of conventional versus endoscopic-assisted surgery for breast phyllodes tumors: a single center retrospective cohort study.Translational breast cancer research : a journal focusing on translational research in breast cancer · 2026Article
- Prevalence, Risk Factors, and Impacts of Musculoskeletal Injuries Among Plastic Surgeons: A Systematic Review and Meta-Analysis.Plastic surgery (Oakville, Ont.) · 2025Review
- Towards Standardized Language to Describe the Pathological Enhancement of the Nipple in NAC-Infiltrating Breast Tumors: A Retrospective Case Series Study.Diagnostics (Basel, Switzerland) · 2025Article
- Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study.Perioperative medicine (London, England) · 2024Article
- Applications of wearable sensors in upper extremity MSK conditions: a scoping review.Journal of neuroengineering and rehabilitation · 2023Article
- Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties.American journal of surgery · 2023Article
- Robotic-Assisted Nipple Sparing Mastectomy.Seminars in plastic surgery · 2023Review
- ASO Author Reflections: How Do We Improve Ergonomics for the Breast Surgeon During Nipple-Sparing Mastectomies?Annals of surgical oncology · 2022Article
- Surgical and Oncologic Outcomes of Robotic and Conventional Nipple-Sparing Mastectomy with Immediate Reconstruction: International Multicenter Pooled Data Analysis.Annals of surgical oncology · 2022Article
- The Relationship Between the NSP and the Individual and Work Organizational Variables: A Cross-Sectional Study.Frontiers in public health · 2022Article
- Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery.Surgical endoscopy · 2021Article
- Multicenter Evaluation of Hydrodissection-Assisted Mastectomy (HAM).Annals of surgical oncology · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBreast 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.
methodsFrom 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.
resultsProcedural 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).
conclusionNipple-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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.