转载自好友公众号：加贝观止医聊室
引言
Introduction
为什么3D内窥镜适合用NASA-TLX来评估？
Why is NASA-TLX suitable for evaluating 3D endoscopes?
因为3D内窥镜产品是一个主观性判断特别鲜明的品类。其实只要是影像视觉类产品，都属于主观性判断的品类。不仅是3D内窥镜，所有其他2D内窥镜，或者CT、B超之类的产品，也是一样。
Because 3D endoscopes represent a category where subjective judgment plays an exceptionally prominent role. In fact, any imaging-based product—including 3D endoscopes—falls into this subjective assessment category. This applies not only to 3D endoscopes but also to all other 2D endoscopes, as well as products like CT scanners and ultrasound devices.
当时在3D内窥镜标准草拟阶段，当时让团队把很多主观项的感觉尽量能用客观数值表现出来。即便是后续标准发布了，检验标准也很难把用户也就是外科医生对这类产品的评价准确衡量。今天试着用NASA-TLX方法论来梳理一下。
During the drafting stage of the 3D endoscope standards, our team made efforts to translate subjective experiences into objective metrics as much as possible. Even after the standards were officially released, accurately measuring user (i.e., surgeon) evaluations of such products remains challenging. Today, I will attempt to use the NASA-TLX methodology to systematically explore this.
上篇是刚学NASA-TLX理论，我用了手术机器人的例子代入了一下。主要是把应用三步曲都走了一遍。
In my previous article, while initially learning NASA-TLX theory, I applied it using surgical robots as an example—mainly walking through the three-step application process.
01 认识3D内窥镜的任务属性
01 Understanding the Task Attributes of 3D Endoscopes
现在要用到3D内窥镜上，是不是只要套用那个公式就行了？
Now, applying NASA-TLX to 3D endoscopes: can we simply reuse the same formula?
不对。
No.
因为我们评价的对象变了，这个产品要帮助医生完成的任务属性也变了。
The subject of evaluation has changed, and the nature of the task the product helps surgeons accomplish has also shifted.
手术机器人其实一个整体临床手术任务的工具；
A surgical robot is a tool designed to support the entire clinical surgical task.
而3D内窥镜是手术机器人的一部分，在整个手术任务中，只是被医生雇佣来完成看见的任务。其实是个子任务。
A 3D endoscope, however, is part of a surgical robot—it is employed by the surgeon solely to fulfill the "seeing" task during the procedure. It is essentially a sub-task.
多啰嗦一句，很多做内窥镜产品的厂家觉得，视觉产品在手术中的重要性极高，也在各种学术会议中把一些话术教给专家，借专家的嘴宣传产品。这其实也是正常情况。根据自己的跟台观察以及以前团队的跟台反馈来看。其实我们有点高估了内窥镜产品在整个手术任务的地位。在很多医生眼里，能顺利把手术做下来，病人内部组织的差异性、手术的整体难度、手术器械的顺手度以及团队的配合默契度，可能都比内窥镜重要。
To elaborate slightly: many endoscope manufacturers believe visual products are critically important in surgery. They often provide key messaging to experts for promotion at academic conferences—a common practice. However, based on my own observations in operating rooms and feedback from previous team members, we may have overestimated the role of endoscopes in the overall surgical task. For many surgeons, factors such as patient anatomical variability, overall surgical difficulty, instrument ergonomics, and team coordination may carry more weight than the endoscope itself.
但也不能说内窥镜产品不重要。你就把内窥镜产品看作车的前窗玻璃。
That said, endoscopes are not unimportant. Think of an endoscope as the windshield of a car.
如果前窗玻璃干净，其实驾驶员就觉察不到这个前窗玻璃的重要性。
If the windshield is clean, the driver hardly notices its importance.
但如果驾驶过程中，前窗玻璃脏了，雨刮怎么刮，也看不清楚前面的路，那驾驶员就要慌了。他会努力睁大眼睛去看路，他心里会想：“会不会因为看不清，有盲区，不小心就撞上什么”。（努力程度和心理压力）
But if the windshield becomes dirty during a drive, and the wipers fail to clear it—making the road ahead blurry—the driver grows anxious. They might strain to see, thinking, "Could there be a blind spot? Could I accidentally hit something?" (Increased effort and mental demand.)
也会因为看不清，就放慢速度，想着只要安全到达就行，速度在看不清的情况下就不追求了。大家想想，内心戏是不是这样的？（时间压力和心理压力）
They might also slow down, prioritizing safety over speed. Does this inner monologue sound familiar? (Increased temporal demand and mental demand.)
上面这段啰里啰嗦的话，就是和3D内窥镜权重调查表的记录表现差异相关了。
This lengthy analogy relates directly to the differences observed in the weighting survey for 3D endoscopes.
也就是，不能直接套用手术机器人的权重系数来看六个维度的比重。
In other words, we cannot directly apply the weight coefficients from surgical robots to assess the six dimensions for 3D endoscopes.
在3D内窥镜这个产品上，权重最大的竟然有努力程度。这个努力程度，就是基于视觉产品特性导致权重系数上升。而在时间压力和受挫程度对比时，3D内窥镜产品在这项可能会倾向于受挫，也可以用上面那个前窗玻璃的示例来理解。
For 3D endoscopes, effort emerged as the highest-weighted dimension. This increase is due to the visual nature of the product. When comparing temporal demand and frustration, 3D endoscopes may lean more toward frustration—again, think of the dirty windshield example.
这就是我上篇文章提到的，做NASA-TLX之前，理解自己的产品到底在医生的任务中起到什么作用。如果对自己的产品没有正确的认知，那从第一步就会错了。这一步一定要客观。
This underscores the point from my previous article: before applying NASA-TLX, understand what role your product actually plays in the surgeon's task. Without an objective understanding, even the first step can go wrong. Getting this right is crucial.
这一步做对了，第2步就是计算题了
If this step is done correctly, Step 2 becomes a straightforward calculation.
第3步也是计算题了
And so does Step 3.
02 打分与产品性能的关系
02 Relationship Between Scoring and Product Performance
心理压力
Mental Demand
3D产品哪些方面会给用户心理压力？
What aspects of a 3D product create mental demand for users?
3D立体视觉迟迟建立不起来；
- Delay in establishing 3D stereoscopic vision.
3D视觉建立起来了，但立体视觉不舒服；
- Discomfort even after 3D vision is established.
手术过程，3D内窥镜出问题了（比如黑屏，闪屏，照明突变，颜色突变，镜子变糊了，怎么擦都擦不干净）；
- Intraoperative issues: black screen, flickering, sudden changes in lighting or color, blurred lens that cannot be cleaned properly.
反正大家就用汽车的前窗玻璃那个例子来对照，3D内窥镜视野干净清爽，让医生在做回顾性评估时，不会有这样消极的深刻印象造成当时手术过程的心理负担，那这个评分就不会低。
Refer back to the car windshield example: if the 3D endoscopic view remains clear and stable, surgeons are unlikely to recall negative impressions during retrospective evaluation, resulting in lower scores for mental demand.
体力压力
Physical Demand
从权重上看，权重为0。大家可能觉得这个比重有点说不过去。这么说吧，在手术机器人这个产品上的3D内窥镜，扶镜子需要的体力不是主刀医生，是机械臂。这个不存在体力消耗。但是如果是腹腔镜手术，是人持镜。那还是没多大关系，因为主刀不拿镜子，这项打分可能没多大意义。
From the weighting survey, this dimension received a weight of 0. Some may question this, but consider: in robotic-assisted surgery, the 3D endoscope is held by a robotic arm—not the surgeon—so physical exertion is negligible. Even in laparoscopic surgery, where an assistant holds the scope, the primary surgeon remains unaffected. Therefore, scoring must always consider the product's usage context.
所以，不能脱离产品的使用场景来打分。
So, scoring cannot be divorced from the product's usage scenario.
时间压力
Temporal Demand
3D产品哪些方面会给用户时间压力？
What aspects create temporal demand for users?
3D立体视觉迟迟建立不起来；
- Delay in establishing 3D stereoscopic vision.
3D纵深感不对，需要多次才能够着目标；
- Incorrect depth perception, requiring multiple attempts to reach the target.
手术过程，3D内窥镜出问题了（比如黑屏，闪屏，照明突变，颜色突变，镜子变糊了，怎么擦都擦不干净）；
- Intraoperative issues (e.g., black screen, flickering, blurring) that prolong procedure time.
很多医院都会把手术时间看得很重，时间是个重要的KPI，如果在手术过程，和擦镜子或者解决3D故障部分很费时间的话，那时间压力分就会很高，另外时间越长，麻醉风险也高，并发症的发生概率也相应增加。这个时间压力，在很多术式中都非常关键，个人认为这个指标的权重一般都很高。
Many hospitals prioritize surgical duration as a key KPI. Delays caused by cleaning the lens or troubleshooting 3D issues can significantly increase temporal demand scores. Longer procedures also elevate anesthesia risks and complication rates. This dimension is critical in many surgeries and generally carries high weight.
努力程度
Effort
3D产品哪些方面会给用户在努力程度带来负担？
What aspects increase user effort?
3D立体视觉迟迟建立不起来；
- Delay in establishing 3D stereoscopic vision.
3D纵深感不对（比如：总是不能准确触及目标，要尝试多次才能找到感觉）
- Incorrect depth perception (e.g., repeated attempts needed to accurately reach the target).
图像问题，看着费劲（比如：清晰度问题，要努力看；颜色区分度问题，要努力辨识才能区分组织）
- Image issues requiring extra concentration (e.g., poor clarity, low color contrast making tissue differentiation difficult).
其实3D产品和2D产品在图像问题上给用户造成的努力程度负担都是差不多的。但3D产品还在建立深度感觉上有很重要的权重。如果这个维度再细分权重打分的话，图像问题的权重肯定不如纵深感。因为纵深感是3D产品的基本属性，和手术时间又密切相关。不管是经验丰富的医生还是新手医生，如果3D内窥镜给医生在纵深感造成了错觉，连触及目标都成问题，那么可能就会成为手术室的笑话。
Both 3D and 2D products impose similar effort burdens related to image quality. However, 3D products add the critical dimension of depth perception. If this dimension were further weighted, image issues would likely rank lower than depth perception. Depth perception is a fundamental attribute of 3D systems and directly impacts surgical time. Whether the surgeon is experienced or a novice, misleading depth cues that hinder accurate targeting can become a serious point of frustration—or even an operating room joke.
受挫程度
Frustration
3D产品哪些方面会给用户在受挫程度带来负担？
What aspects lead to user frustration?
3D立体视觉迟迟建立不起来；
- Delay in establishing 3D stereoscopic vision.
3D纵深感不对（比如：总是不能准确触及目标，要尝试多次才能找到感觉）
- Incorrect depth perception (e.g., repeated failed attempts to reach the target).
可以看前面纵深感的分析，纵深感带来的挫败感是直接的。
As analyzed above, depth perception issues are a direct source of frustration.
图像问题，因为图像误判，做了不该做的动作，或者造成了医源性伤害。
- Image misinterpretation leading to incorrect actions or iatrogenic injury.
整体表现负担
Own Performance (Perceived Performance)
我的理解：结合以上五点，用户对自己在整个手术中感受到的负担打分。再次提醒，这个分数越高，表示对自己的表现越不满意，注意注意，是整体表现负担。
My understanding: This score reflects the user’s overall perceived burden during the surgery, synthesized from the above five dimensions. Reminder: A higher score indicates greater dissatisfaction with one’s own performance—it is a measure of performance burden.
结语
Conclusion
这样梳理之后，后续如果设计临床研究课题。该如何设计评价问卷就清楚了。另外，如果拿到产品评价结果了，也可以准确知道用户觉得不好的原因了。而不是一句笼统的“效果不行”。
After this structured analysis, designing clinical study questionnaires becomes clearer. Moreover, when evaluation results are obtained, we can precisely identify why users find certain aspects unsatisfactory—rather than settling for vague feedback like "the effect isn’t good enough."
