BACKGROUND: Image-guided navigation (IGN) represents a first step in the automation of surgical functions. The use of IGN can involve several human factors issues that must be taken into account when evaluating their impact on surgical performance and patient safety. METHODS: A nationwide survey was conducted among 213 surgeons from 112 German hospitals in order to assess the perceived performance consequences and human factors issues of IGN, including changes of situation awareness, performance and workload, as well as issues of overreliance, skill degradation and usability. RESULTS: Generally, surgeons report improved performance and patient safety related to the use of IGN. However, issues of increased time pressure and mental demands were reported by inexperienced users. Furthermore, overreliance on IGN represents a risk, albeit only in a minority of respondents. CONCLUSIONS: IGN is evaluated as a helpful tool for surgeons. However, special care should be taken to provide surgeons with sufficient time and training during familiarization with an IGN system.
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