{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T23:06:27Z","timestamp":1780355187104,"version":"3.54.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T00:00:00Z","timestamp":1662336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Assess the surgeons' workload during deep endometriosis surgery after ureteral ICG<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective, consecutive, comparative, single-center study<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>41 patients enrolled to deep endometriosis surgery with ureteral ICG from January 2019 to July 2021 at La Paz University Hospital<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were divided into 2 groups: patients operated during the learning curve of ureteral ICG instillation and patients operated after the technique was implemented and routinely performed. After surgery, the SURG-TLX form was completed by the surgeons. We evaluated whether a workload reduction occurred.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcomes measures<\/jats:title><jats:p>Surgeon's workload was measured using the SURG-TLX form, obtaining the total workload and 6 different dimensions (distractions, temporal demands, task complexity, mental demands, situational stress and physical demands)<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A significant positive correlation was found between surgical complexity and situational stress (<jats:italic>p<\/jats:italic>\u2009=\u20090.04). Mental demands (<jats:italic>p<\/jats:italic>\u2009=\u20090.021), physical demands (<jats:italic>p<\/jats:italic>\u2009=\u20090.03), and total workload (<jats:italic>p<\/jats:italic>\u2009=\u20090.025) were significantly lower when the technique was routinely performed. The mental demand, physical demands, and total workload perceived by the surgeons at the beginning of the implementation was higher (68 [39\u201372], 27 [11\u201346.5], 229 [163\u2013240], respectively) than in the latter ones (40 [9\u201363], 11.5 [0\u201332.8], 152 [133.3\u2013213.8], respectively). Distractions appeared to be higher in the latter surgeries (8.5 [0\u201327.8]) than in the first surgeries (0 [0\u20137]; <jats:italic>p<\/jats:italic>\u2009=\u20090.057).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Ureter ICG instillation prior to DE surgery significantly reduces the mental and physical demands and total workload of the surgeons in DE surgeries after overcoming the learning curve. Distractions appear to increase as surgical stress decreases.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.982922","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T04:36:55Z","timestamp":1662352615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Surgeons' workload assessment during indocyanine-assisted deep endometriosis surgery using the surgery task load index: The impact of the learning curve"],"prefix":"10.3389","volume":"9","author":[{"given":"Emanuela","family":"Spagnolo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Crist\u00f3bal Quevedo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Gort\u00e1zar de las Casas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"L\u00f3pez Carrasco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Carbonell L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Pascual Miguel\u00e1\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Hern\u00e1ndez Guti\u00e9rrez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,5]]},"reference":[{"key":"B1","first-page":"349","article-title":"Endometriosis still a challenge","volume":"7","author":"Mehedintu","year":"2014","journal-title":"J Med Life"},{"key":"B2","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/S0015-0282(16)54244-7","article-title":"Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain","volume":"55","author":"Koninckx","year":"1991","journal-title":"Fertil Steril"},{"key":"B3","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1148\/radiol.14132803","article-title":"Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography-initial results","volume":"273","author":"Rousset","year":"2014","journal-title":"Radiology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/S0009-739X(07)71296-4","article-title":"Endometriosis intestinal. Estado actual","volume":"81","author":"Bianchi","year":"2007","journal-title":"Cir Esp"},{"key":"B5","doi-asserted-by":"publisher","first-page":"100083","DOI":"10.1016\/j.eurox.2019.100083","article-title":"Post-operative complications and recurrence rate after treatment of bowel endometriosis: comparison of three techniques","volume":"4","author":"Hern\u00e1ndez Guti\u00e9rrez","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol X"},{"key":"B6","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.fertnstert.2012.06.029","article-title":"Pathogenesis and pathophysiology of endometriosis","volume":"98","author":"Burney","year":"2012","journal-title":"Fertil Steril"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2748","DOI":"10.1016\/j.juro.2009.08.019","article-title":"Laparoscopic management of ureteral endometriosis: the stanford university hospital experience with 96 consecutive cases","volume":"182","author":"Bosev","year":"2009","journal-title":"J Urol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1093\/humrep\/deu360","article-title":"Histological evaluation of ureteral involvement in women with deep infiltrating endometriosis: analysis of a large series","volume":"30","author":"Seracchioli","year":"2015","journal-title":"Hum Reprod"},{"key":"B9","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1093\/humupd\/dmy027","article-title":"Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility","volume":"24","author":"Barra","year":"2018","journal-title":"Hum Reprod Update"},{"key":"B10","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/j.jmig.2006.07.012","article-title":"Treatment of urinary tract endometriosis","volume":"13","author":"Gustilo-Ashby","year":"2006","journal-title":"J Minim Invasive Gynecol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.fertnstert.2014.09.028","article-title":"Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification","volume":"103","author":"Knabben","year":"2015","journal-title":"Fertil Steril"},{"key":"B12","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.urology.2008.08.470","article-title":"Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects","volume":"73","author":"P\u00e9rez-Utrilla P\u00e9rez","year":"2009","journal-title":"Urology"},{"key":"B13","first-page":"184","article-title":"Novel [corrected] medical management of primary bladder endometriosis with dienogest: a case report","volume":"38","author":"Takagi","year":"2011","journal-title":"Clin Exp Obstet Gynecol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1080\/01443615.2017.1349083","article-title":"Severe ureteral endometriosis: frequency and risk factors","volume":"38","author":"Raimondo","year":"2018","journal-title":"J Obstet Gynaecol (Lahore)"},{"key":"B15","author":"de Trabajo","year":""},{"key":"B16","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1177\/155335060501200112","article-title":"Assessing mental workload during laparoscopic surgery","volume":"12","author":"Carswell","year":"2005","journal-title":"Surg Innov"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.1007\/s00268-011-1141-4","article-title":"Development and validation of a surgical workload measure: the surgery task load index (SURG-TLX)","volume":"35","author":"Wilson","year":"2011","journal-title":"World J Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.jmig.2020.04.004","article-title":"Use of indocyanine green for intraoperative perfusion assessment in women with ureteral endometriosis: a preliminary study","volume":"28","author":"Raimondo","year":"2021","journal-title":"J Minim Invasive Gynecol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"727725","DOI":"10.3389\/fonc.2021.727725","article-title":"Indocyanine green to assess vascularity of ileal conduit anastomosis during pelvic exenteration for recurrent\/persistent gynecological cancer: a pilot study","volume":"11","author":"Bizzarri","year":"2021","journal-title":"Front Oncol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1002\/ijgo.13959","article-title":"Preoperative ureteral stenting in women with deep posterior endometriosis and ureteral involvement: is it useful?","volume":"158","author":"Borghese","year":"2022","journal-title":"Int J Gynecol Obstet"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1111\/codi.15093","article-title":"Bowel and ureteral assessment by indocyanine green real-time visualization during deep infiltrating endometriosis surgery - a video vignette","volume":"22","author":"Spagnolo","year":"2020","journal-title":"Colorectal Dis"},{"key":"B22","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.1007\/s00586-005-1044-x","article-title":"Pain assessment","author":"Haefeli","year":"2006","journal-title":"Eur Spine J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3393\/ac.2021.00829.0118","article-title":"Short-term outcomes in patients undergoing laparoscopic surgery for deep infiltrative endometriosis with rectal involvement: a single-center experience of 168 cases","author":"de Las","year":"2022","journal-title":"Ann Coloproctol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/13645706.2022.2064715","article-title":"Role of fluorescence imaging for intraoperative intestinal assessment in gynecological surgery: a systematic review","author":"Spagnolo","year":"2022","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1097\/SLA.0000000000001051","article-title":"The impact of operating room distractions on stress, workload, and teamwork","volume":"261","author":"Wheelock","year":"2015","journal-title":"Ann Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.surg.2009.10.007","article-title":"The impact of stress on surgical performance: a systematic review of the literature","volume":"147","author":"Arora","year":"2010","journal-title":"Surgery"},{"key":"B28","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.fertnstert.2017.10.001","article-title":"Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases","volume":"109","author":"Abo","year":"2018","journal-title":"Fertil Steril"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1111\/aogs.13866","article-title":"Real three-dimensional approach vs two-dimensional camera with and without real-time near-infrared imaging with indocyanine green for detection of endometriosis: a case-control study","volume":"99","author":"Vizzielli","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"B30","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s11701-019-00933-2","article-title":"Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries","volume":"14","author":"Mendes","year":"2020","journal-title":"J Robot Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1007\/s00404-020-05870-2","article-title":"Training for next generation surgeons: a pilot study of robot-assisted hysterectomy managed by resident using dual console","volume":"303","author":"Klapczynski","year":"2021","journal-title":"Arch Gynecol Obstet"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14089","article-title":"Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function","author":"Ianieri","year":"2022","journal-title":"Int J Gynecol Obstet"},{"key":"B33","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.apergo.2018.06.005","article-title":"Surgical team workload comparison for 4-port and single-port laparoscopic cholecystectomy procedures","volume":"78","author":"Lowndes","year":"2019","journal-title":"Appl Ergon"},{"key":"B34","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s00464-009-0522-3","article-title":"Measuring mental workload during the performance of advanced laparoscopic tasks","volume":"24","author":"Zheng","year":"2010","journal-title":"Surg Endosc"},{"key":"B35","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1001\/jamasurg.2020.0034","article-title":"Robotic inguinal vs transabdominal laparoscopic inguinal hernia repair: the RIVAL randomized clinical trial","volume":"155","author":"Prabhu","year":"2020","journal-title":"JAMA Surg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1097\/SLA.0000000000000253","article-title":"A noise-reduction program in a pediatric operation theatre is associated with surgeon's Benefits and a reduced rate of complications: a prospective controlled clinical trial","volume":"259","author":"Engelmann","year":"2014","journal-title":"Ann Surg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1001\/archsurg.143.11.1068","article-title":"Impact of preoperative briefings on operating room delays: a preliminary report","volume":"143","author":"Nundy","year":"2008","journal-title":"Arch Surg"},{"key":"B38","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.contraception.2019.05.003","article-title":"Relationship between body mass index and operative time in women receiving immediate postpartum tubal ligation","volume":"100","author":"Deshpande","year":"2019","journal-title":"Contraception"},{"key":"B39","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1097\/SLA.0b013e31823dcbf7","article-title":"The impact of obesity on perioperative outcomes after laparoscopic colorectal resection","volume":"255","author":"Makino","year":"2012","journal-title":"Ann Surg"},{"key":"B40","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1177\/1553350620934931","article-title":"Surgery task load Index in cardiac surgery: measuring cognitive load among teams","volume":"27","author":"Kennedy-Metz","year":"2020","journal-title":"Surg Innov"},{"key":"B41","first-page":"hoaa002","article-title":"Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis","volume-title":"Hum Reprod Open","author":"Keckstein","year":"2020"},{"key":"B42","doi-asserted-by":"publisher","first-page":"853902","DOI":"10.1155\/2014\/853902","article-title":"Posterior deep infiltrating endometriotic nodules: operative considerations according to lesion size, location, and geometry, during one\u2019s learning curve","author":"Protopapas","year":"2014","journal-title":"ISRN Obstet Gynecol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"f5588","DOI":"10.1136\/bmj.f5588","article-title":"Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis","volume":"347","author":"Ten Broek","year":"2013","journal-title":"Br Med J"},{"key":"B44","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1097\/DCR.0b013e31827ba103","article-title":"Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery","volume":"56","author":"Yamamoto","year":"2013","journal-title":"Dis Colon Rectum"},{"key":"B45","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/s12905-015-0230-1","article-title":"The impact of previous ovarian surgery on ovarian reserve in patients with endometriosis","volume":"15","author":"Chiang","year":"2015","journal-title":"BMC Womens Health"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.982922\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T04:37:02Z","timestamp":1662352622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.982922\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,5]]},"references-count":45,"alternative-id":["10.3389\/fsurg.2022.982922"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.982922","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,5]]},"article-number":"982922"}}