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Budden AK, Henry A, Wakefield CE, Abbott JA. Surgeon stress, anxiety, and workload: a descriptive study of participant reported responses to fundamentals of laparoscopic surgery exercises. Surg Endosc 2024:10.1007/s00464-024-11238-3. [PMID: 39271514 DOI: 10.1007/s00464-024-11238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Stress while operating is an important contributor to surgeon health and burnout. Measuring stress is key to improving surgeon and patient outcomes, however biological responses to stress during surgery are variable and difficult to interpret. Participant reported measures of stress have been suggested as an alternative, but the most appropriate measure has not been defined. This study's primary aim was to assess measures of anxiety, stress, and workload before and after surgical simulation and characterize the relationship between these measures. METHODS Surgeons completed three laparoscopic exercises from the fundamentals of laparoscopy program (peg transfer, pattern cutting, intracorporeal suturing) in a neutral environment and "stressed" environment (ergonomic, noise, or time pressure). State trait anxiety and self-reported stress on a visual analogue scale were collected prior to simulation and again immediately afterwards. The NASA task load index (TLX) was also administered post-simulation. RESULTS Of the 26 participants from gynecological and general surgery specialties, state anxiety increased in 98/148 simulations (62%) with a significant mean increase during simulation (32.9 ± 7.9 vs 39.4 ± 10.2, p < .001). Self-reported stress increased in 107/148 simulations (72%), with a significant increase in mean scores during simulation (38.7 ± 22.5 vs 48.9 ± 23.7, p < .001). NASA-TLX scores immediately after simulation ranged from 40 to 118 (mean 60.5 ± 28.7). Greater anxiety and stress scores were reported in "stressed" simulations (43.6 ± 23.1 vs 54.2 ± 23.3; 68.7 ± 27.0 vs 52.4 ± 28.2 respectively) with a significant interaction effect of the "stressed" environment and type of exercise. Anxiety and stress were moderately positively correlated prior to simulation (r = .40) and strongly positively correlated post-simulation (r = .70), however only stress was strongly correlated to workload (r = .79). CONCLUSION Stress and anxiety varied by type of laparoscopic exercise and simulation environment. Correlations between anxiety and stress are stronger post-simulation than prior to simulation. Stress, but not anxiety, is highly correlated with workload.
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Affiliation(s)
- Aaron K Budden
- Discipline of Women's Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia.
- Gynaecological Research and Clinical Evaluation (GRACE), Royal Hospital for Women, Sydney, Australia.
- Department of Obstetrics and Gynaecology, Coffs Harbour Hospital, 343 Pacific Highway, Coffs Harbour, 2450, Australia.
| | - Amanda Henry
- Discipline of Women's Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, Australia
- The George Institute for Global Health, UNSW Medicine and Health, Sydney, Australia
| | - Claire E Wakefield
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Behavioural Sciences Unit, Sydney Children's Hospital, Sydney, Australia
| | - Jason A Abbott
- Discipline of Women's Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE), Royal Hospital for Women, Sydney, Australia
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Georgiou K, Boyanov N, Thanasas D, Sandblom G, Linardoutsos D, Enochsson L. Saliva stress biomarkers in ERCP trainees before and after familiarisation with ERCP on a virtual simulator. Front Surg 2024; 11:1364195. [PMID: 38952438 PMCID: PMC11215138 DOI: 10.3389/fsurg.2024.1364195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
Background Stress during the early ERCP learning curve may interfere with acquisition of skills during training. The purpose of this study was to compare stress biomarkers in the saliva of trainees before and after familiarisation with ERCP exercises on a virtual simulator. Methods Altogether 26 endoscopists under training, 14 women and 12 men, completed the three phases of this study: Phase 1. Three different ERCP procedures were performed on the simulator. Saliva for α-amylase (sAA), Chromogranin A (sCgA), and Cortisol (sC) were collected before (baseline), halfway through the exercise (ex.), and 10 min after completion of the exercise (comp.); Phase 2. A three-week familiarisation period where at least 30 different cases were performed on the virtual ERCP simulator; and Phase 3. Identical to Phase 1 where saliva samples were once again collected at baseline, during, and after the exercise. Percentage differences in biomarker levels between baseline and exercise (Diffex) and between baseline and completion (Diffcomp) during Phase 1 and Phase 3 were calculated for each stress marker. Results Mean % changes, Diffex and Diffcomp, were significantly positive (p < 0.05) for all markers in both Phase 1 and Phase 3. Diffex in Phase 1 was significantly greater than Diffex in Phase 3 (p < 0.05) for sAA and sCgA. Diffcomp for sAA in Phase 1 was significantly greater than Diffcomp in Phase 3 (p < 0.05). No significant differences were found in sC concentration between Phases 1 and 3. Conclusion This study shows that familiarisation with the ERCP simulator greatly reduced stress as measured by the three saliva stress biomarkers used with sAA being the best. It also suggests that familiarisation with an ERCP simulator might reduce stress in the clinical setting.
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Affiliation(s)
- Konstantinos Georgiou
- 1st Department of Propaedeutic Surgery, Hippocrateion Athens General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikola Boyanov
- Medical Simulation Training Centre, Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Dimitrios Thanasas
- Medical Physics Laboratory Simulation Centre, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Dimitrios Linardoutsos
- 1st Department of Propaedeutic Surgery, Hippocrateion Athens General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lars Enochsson
- Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden
- Department of Clinical Science, Interventions and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
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Bartholomew RA, Zhou H, Boreel M, Suresh K, Gupta S, Mitchell MB, Hong C, Lee SE, Smith TR, Guenette JP, Corrales CE, Jagadeesan J. Surgical Navigation in the Anterior Skull Base Using 3-Dimensional Endoscopy and Surface Reconstruction. JAMA Otolaryngol Head Neck Surg 2024; 150:318-326. [PMID: 38451508 PMCID: PMC11009826 DOI: 10.1001/jamaoto.2024.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/07/2024] [Indexed: 03/08/2024]
Abstract
Importance Image guidance is an important adjunct for endoscopic sinus and skull base surgery. However, current systems require bulky external tracking equipment, and their use can interrupt efficient surgical workflow. Objective To evaluate a trackerless surgical navigation system using 3-dimensional (3D) endoscopy and simultaneous localization and mapping (SLAM) algorithms in the anterior skull base. Design, Setting, and Participants This interventional deceased donor cohort study and retrospective clinical case study was conducted at a tertiary academic medical center with human deceased donor specimens and a patient with anterior skull base pathology. Exposures Participants underwent endoscopic endonasal transsphenoidal dissection and surface model reconstruction from stereoscopic video with registration to volumetric models segmented from computed tomography (CT) and magnetic resonance imaging. Main Outcomes and Measures To assess the fidelity of surface model reconstruction and accuracy of surgical navigation and surface-CT model coregistration, 3 metrics were calculated: reconstruction error, registration error, and localization error. Results In deceased donor models (n = 9), high-fidelity surface models of the posterior wall of the sphenoid sinus were reconstructed from stereoscopic video and coregistered to corresponding volumetric CT models. The mean (SD; range) reconstruction, registration, and localization errors were 0.60 (0.24; 0.36-0.93), 1.11 (0.49; 0.71-1.56) and 1.01 (0.17; 0.78-1.25) mm, respectively. In a clinical case study of a patient who underwent a 3D endoscopic endonasal transsphenoidal resection of a tubercular meningioma, a high-fidelity surface model of the posterior wall of the sphenoid was reconstructed from intraoperative stereoscopic video and coregistered to a volumetric preoperative fused CT magnetic resonance imaging model with a root-mean-square error of 1.38 mm. Conclusions and Relevance The results of this study suggest that SLAM algorithm-based endoscopic endonasal surgery navigation is a novel, accurate, and trackerless approach to surgical navigation that uses 3D endoscopy and SLAM-based algorithms in lieu of conventional optical or electromagnetic tracking. While multiple challenges remain before clinical readiness, a SLAM algorithm-based endoscopic endonasal surgery navigation system has the potential to improve surgical efficiency, economy of motion, and safety.
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Affiliation(s)
- Ryan A. Bartholomew
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Haoyin Zhou
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Maud Boreel
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Krish Suresh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Margaret B. Mitchell
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christopher Hong
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stella E. Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jeffrey P. Guenette
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - C. Eduardo Corrales
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jayender Jagadeesan
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
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Budden AK, Song S, Henry A, Wakefield CE, Abbott JA. Surgeon reported measures of stress and anxiety prior to and after elective gynecological surgery. Acta Obstet Gynecol Scand 2024; 103:360-367. [PMID: 38053225 PMCID: PMC10823402 DOI: 10.1111/aogs.14728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Performing surgical procedures is a recognized source of stress for surgeons. Vocational stress is an important contributor to performance, patient care, and burnout with dispositional and environmental factors contributing. Accurately assessing surgeon stress is critical to measuring effectiveness of stress reduction programs. The primary aim was to identify differences between surgeons' self-reported anticipated stress and anxiety prior to gynecological surgery, compared with their recollection of experienced stress and anxiety during surgery. Secondary aims assessed any differences by level of training, surgical type, and surgeon role. MATERIAL AND METHODS Attending and resident gynecologists performing routine elective surgeries completed a visual analog scale (VAS) assessing perceived stress and the State-Trait Anxiety Inventory (STAI) prior to and immediately after completing 161 elective surgeries including total laparoscopic hysterectomy, laparoscopic excision of moderate-severe endometriosis, or hysteroscopic myomectomy. RESULTS Eight attending gynecologists and nine residents participated. Residents commenced as primary surgeon in 62/90 (69%) procedures. Stress experienced during surgery was greater than anticipated in 92/161 (57%) surgery episodes (mean VAS increase: 3.9; 95% CI: 1.1-6.8, p = 0.009). State anxiety was greater than anticipated in 99/161 (62%) episodes (mean state anxiety increase: 4.4; 95% CI: 3.0-5.8, p < 0.001). Greater preprocedural anticipatory stress and anxiety was observed in residents vs. attending gynecologists (VAS 51.9 vs. 22.8, p < 0.001; state anxiety 38.3 vs. 28.1, p < 0.001) and in primary vs. assistant surgeons (VAS 47.2 vs. 29.9, p < 0.001; state anxiety 36.9 vs. 28.3, p < 0.001). Intraoperative stress and anxiety were greater in primary surgeons (VAS 50.4 vs. 30.5, p < 0.001; anxiety 41.3 vs. 32.5, p < 0.001) and residents (VAS 43.4 vs. 31.7, p < 0.001; anxiety 53.5 vs. 33.7, p < 0.001) compared with assistants and attending gynecologists. Perceived stress and anxiety were positively correlated at both timepoints (r = 0.68, p < 0.001; r = 0.82, p < 0.001). CONCLUSIONS When asked to reflect on stress experienced during surgery, our data show that stress during surgery is greater than anticipated for many surgical episodes. Self-reported stress symptoms commence prior to surgery and are more commonly reported by surgeons operating as primary surgeon and by those in training. Future research should focus on determinants of presurgical stress and examine when stressors become inhibitory to performance.
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Affiliation(s)
- Aaron K. Budden
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Gynecology Research and Clinical Excellence (GRACE)Royal Hospital for WomenSydneyNew South WalesAustralia
| | - Sophia Song
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Gynecology Research and Clinical Excellence (GRACE)Royal Hospital for WomenSydneyNew South WalesAustralia
| | - Amanda Henry
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Department of Women's and Children's HealthSt George HospitalSydneyNew South WalesAustralia
| | - Claire E. Wakefield
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Kids Cancer CenterSydney Children's HospitalSydneyNew South WalesAustralia
| | - Jason A. Abbott
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Gynecology Research and Clinical Excellence (GRACE)Royal Hospital for WomenSydneyNew South WalesAustralia
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Suzuki M, Miyaji K, Matoba K, Abe T, Nakamaru Y, Watanabe R, Suzuki T, Nakazono A, Konno A, Hinder D, Psaltis AJ, Wormald PJ, Homma A. Mental workload during endoscopic sinus surgery is associated with surgeons' skill levels. Front Med (Lausanne) 2023; 10:1090743. [PMID: 37168266 PMCID: PMC10165102 DOI: 10.3389/fmed.2023.1090743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/04/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Surgeons' mental workload during endoscopic sinus surgery (ESS) has not been fully evaluated. The assessment was challenging due to the great diversity of each patient's anatomy and the consequence variety of surgical difficulties. In this study, we examined the mental workload of surgeons with various surgical skill levels during ESS under the standardized condition provided by novel-designed 3D sinus models. Materials and methods Forty-seven participants performed a high-fidelity ESS simulation with 3D-printed sinus models. Surgeons' mental workload was assessed with the national aeronautics and space administration-task load index (NASA-TLX). Associations between the total and subscales score of NASA-TLX and surgical skill index, including the board certification status, the number of experienced ESS cases, and the objective structured assessment of technical skills (OSATS), were analyzed. In addition, 10 registrars repeated the simulation surgery, and their NASA-TLX score was compared before and after the repetitive training. Results The total NASA-TLX score was significantly associated with OSATS score (p = 0.0001). Primary component analysis classified the surgeons' mental burden into three different categories: (1) the skill-level-dependent factors (temporal demand, effort, and performance), (2) the skill-level-independent factors (mental and physical demand), and (3) frustration. After the repetitive training, the skill-level-dependent factors were alleviated (temporal demand; z = -2.3664, p = 0.0091, effort; z = -2.1704, p = 0.0346, and performance; z = -2.5992, p = 0.0017), the independent factors were increased (mental demand; z = -2.5992, p = 0.0023 and physical demand; z = -2.2509, p = 0.0213), and frustration did not change (p = 0.3625). Conclusion Some of the mental workload during ESS is associated with surgical skill level and alleviated with repetitive training. However, other aspects remain a burden or could worsen even when surgeons have gained surgical experience. Routine assessment of registrars' mental burdens would be necessary during surgical training to sustain their mental health.
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Affiliation(s)
- Masanobu Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- *Correspondence: Masanobu Suzuki,
| | - Kou Miyaji
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Kotaro Matoba
- Department of Forensic Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ryosuke Watanabe
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takayoshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Akira Nakazono
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsushi Konno
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Dominik Hinder
- Department of Surgery–Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - A. J. Psaltis
- Department of Surgery–Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - P. J. Wormald
- Department of Surgery–Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Guzmán-García C, Sánchez-González P, Margallo JAS, Snoriguzzi N, Rabazo JC, Margallo FMS, Gómez EJ, Oropesa I. Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics. SENSORS 2022; 22:s22030837. [PMID: 35161582 PMCID: PMC8838092 DOI: 10.3390/s22030837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness' metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants' expertise. The results show that both the mean normalized GSR signal and average surgical instrument's acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.
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Affiliation(s)
- Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Juan A. Sánchez Margallo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | - Nicola Snoriguzzi
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - José Castillo Rabazo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Correspondence: ; Tel.: +34-910-672-458
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Boyanov N, Georgiou K, Thanasas D, Deneva T, Oussi N, Marinov B, Enochsson L. Use of saliva stress biomarkers to estimate novice male endoscopist's stress during training in a high-end simulator. Scand J Gastroenterol 2021; 56:1380-1385. [PMID: 34424793 DOI: 10.1080/00365521.2021.1965208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Simulated endoscopic training can be challenging and stressful for the novice trainee. The absence of a reliable stress detection method during simulated endoscopic training makes estimating trainees' mental stress difficult to quantify. This study concomitantly measures the responses of four saliva stress biomarkers and compares them to the video score (VS) achieved by novice endoscopists in a reproducibly stressful simulation environment. METHODS Thirty-six male endoscopy naïve surgery residents were enrolled. After an orientation phase, a saliva specimen was collected for cortisol (sC), alpha-amylase (sAA), Chromogranin A (sCgA), and immunoglobulin A (sIgA) measurements (baseline phase, BL). Thereafter, the simulation exercise phase (E) started, practicing in the Fundamentals of Endoscopic Surgery Skills module (GI-Bronch Mentor). Immediately after, a second saliva sample for measuring the above-cited biomarkers was collected. The whole experiment was videotaped, and the VS was calculated. The percentage (E-BL)diff of each of the four saliva biomarkers was calculated and examined for correlation to VS. RESULTS sCgAdiff showed the best correlation with VS, followed by sAAdiff. CONCLUSIONS sCgA and sAA, are saliva stress biomarkers that are easy to collect non-invasively and showed the best correlation with novice endoscopist's performance in our simulation setting, and therefore, they could be used for monitoring stress.
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Affiliation(s)
- Nikola Boyanov
- Medical Simulation Training Center at Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Konstantinos Georgiou
- 1st Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Thanasas
- Medical Physics Laboratory Simulation Center, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tanya Deneva
- Central Clinical Laboratory, University Hospital St. George, Plovdiv, Bulgaria.,Department of Clinical Laboratory, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Ninos Oussi
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Blagoi Marinov
- Medical Simulation Training Center at Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Kaushik J, Pannu A, Chaitanya YVK, Kumar A, Parihar JKS, Jain VK, Chaturvedi P, Manumala LK, Singh A, Kochhar D. Effect of complicated ocular surgery in stress-related parameters: A novel outlook into surgeon's health. Indian J Ophthalmol 2021; 69:2282-2286. [PMID: 34427199 PMCID: PMC8544032 DOI: 10.4103/ijo.ijo_3517_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To assess the stress-related physiological parameters of ophthalmic surgeons during complicated cataract surgery and compare them with uncomplicated routine cataract surgery. Methods: In this cross-sectional observational study, 110 patients of various types of cataract were divided into two groups: Group 1 included 55 patients with simple cataract (Grade ≤3) with no ocular or systemic comorbidities, whereas Group 2 included 55 patients with complicated cataracts (Grade >3) and ocular/systemic comorbidities. All patients underwent phacoemulsification with intraocular lens implantation in the right eye only. The outcome measures were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and saturation of peripheral oxygen (SpO2). Results: The average SBP, DBP, MAP, and HR were significantly higher in the surgeon operating Group 2 (complicated cataract) compared with Group 1 (uncomplicated cataract; P < 0.05). The average SBP of the surgeon while operating Group 1 patients preoperatively and postoperatively was 125.42 ± 2.49 mmHg and 122.45 ± 2.10 mmHg, respectively, whereas in Group 2, the average SBP of the surgeon taken preoperatively and postoperatively was 145.98 ± 3.80 mmHg and 137.44 ± 3.45 mmHg, respectively (P < 0.05). The surgeon’s SpO2 showed no significant difference between the two groups. Conclusion: There is a significant level of increase in stress-related parameters of operating surgeons while doing complicated cataract surgery.
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Affiliation(s)
- Jaya Kaushik
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Anju Pannu
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Y V K Chaitanya
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ashok Kumar
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Vaibhav K Jain
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Lalita K Manumala
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ankita Singh
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Divya Kochhar
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
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9
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Affiliation(s)
- Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Road No 2, Banjara Hills, Hyderabad, Telangana, India
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10
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Yiasemidou M, Mushtaq F, Basheer M, Galli R, Panagiotou D, Stock S, Preston N, Mon-Williams M, Jayne DG, Miskovic D. Patient-specific mental rehearsal with three-dimensional models before low anterior resection: randomized clinical trial. BJS Open 2020. [PMCID: PMC7944490 DOI: 10.1093/bjsopen/zraa004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background It was hypothesized that preparing for a surgical procedure, taking into account individual patient characteristics, may facilitate the procedure and improve surgical quality. The aim of this study was to compare different case-specific, preoperative mental rehearsal methods before minimally invasive rectal cancer surgery. Methods In this RCT, patients were allocated in a 1 : 1 : 1 : 1 ratio to four groups: systematic mental rehearsal (SMR) using MRI scans; SMR and three-dimensional (3D) virtual models; SMR and synthetic 3D printed models; and routine practice (control group). Surgeons operating on all but the control group underwent mental rehearsal with the visual aids, including axial MRI scans of the pelvis, interactive 3D virtual models reconstructed from axial MRIs, and synthetic models, manufactured by 3D printing. Operations were video-recorded and assessed by two experts blinded to allocation using two validated scores, the Competency Assessment Tool (CAT) and Objective Clinical Human Reliability Analysis (OCHRA). The primary outcome of the study was surgical performance, measured by the CAT. Results Forty-nine patients were randomized and allocated to the four groups. There were 12 participants in each of the control, MRI and SMR, and virtual and SMR groups, whereas the SMR using physical models and simulation group included 13. No difference was observed between groups in median CAT scores (control 30.50, MRI 34.25, virtual 31.75, physical 34.00; P = 0.748, partial η2 <0.001, where pη2 is indicative of effect size) or OCHRA scores (anterior, posterior, right and left lateral planes, transection P>0.200, pη2 =0.052–0.088). Time spent not performing dissection was significantly shorter for the SMR with MRI group than for the control (57.5 versus 42 respectively; P < 0.001, pη2 =0.212). Conclusion Mental rehearsal did not affect CAT and OCHRA scores of consultant surgeons. Reference number: ISRCTN 75603704 (https://www.isrctn.com).
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Affiliation(s)
- M Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Academic Surgery, University of Hull, Hull, UK
| | - F Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
| | - M Basheer
- Department of Colorectal Surgery, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - R Galli
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Panagiotou
- General Surgery, York Teaching Hospital, York, UK
| | - S Stock
- General and Trauma Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - N Preston
- School of Psychology, University of Leeds, Leeds, UK
| | | | - D G Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Miskovic
- Department of Colorectal Surgery, St Mark’s Hospital, Harrow, London, UK
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11
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Physiological correlates of cognitive load in laparoscopic surgery. Sci Rep 2020; 10:12927. [PMID: 32737352 PMCID: PMC7395129 DOI: 10.1038/s41598-020-69553-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery can be exhausting and frustrating, and the cognitive load experienced by surgeons may have a major impact on patient safety as well as healthcare economics. As cognitive load decreases with increasing proficiency, its robust assessment through physiological data can help to develop more effective training and certification procedures in this area. We measured data from 31 novices during laparoscopic exercises to extract features based on cardiac and ocular variables. These were compared with traditional behavioural and subjective measures in a dual-task setting. We found significant correlations between the features and the traditional measures. The subjective task difficulty, reaction time, and completion time were well predicted by the physiology features. Reaction times to randomly timed auditory stimuli were correlated with the mean of the heart rate (\documentclass[12pt]{minimal}
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\begin{document}$$r = 0.4$$\end{document}r=0.4). Completion times were correlated with the physiologically predicted values with a correlation coefficient of 0.84. We found that the multi-modal set of physiology features was a better predictor than any individual feature and artificial neural networks performed better than linear regression. The physiological correlates studied in this paper, translated into technological products, could help develop standardised and more easily regulated frameworks for training and certification.
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12
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Beswick DM, Ramakrishnan VR. The Utility of Image Guidance in Endoscopic Sinus Surgery. JAMA Otolaryngol Head Neck Surg 2020; 146:286-290. [DOI: 10.1001/jamaoto.2019.4161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Daniel M. Beswick
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado, Aurora
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13
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Acute Stress and Anxiety in Medical Residents on the Emergency Department Duty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018. [PMID: 29534002 PMCID: PMC5877051 DOI: 10.3390/ijerph15030506] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The objectives of this longitudinal study were to compare salivary cortisol release patterns in medical residents and their self-perceived anxiety levels between a regular working day and a day when on call in the emergency department (ED-duty day) and to determine any differences in cortisol release pattern as a function of years of residency or sex. The study included 35 residents (physicians-in-training) of the Granada University Hospital, Granada, Spain. Acute stress was measured on a regular working day and an ED-duty day, evaluating anxiety-state with the Spanish version of the State-Trait Anxiety Inventory. Physiological stress assessment was based on salivary cortisol levels. Cortisol release concentrations were higher on an ED-duty day than on a regular working day, with a significantly increased area under the curve (AUC) (p < 0.006). This difference slightly attenuated with longer residency experience. No gender difference in anxiety levels was observed (p < 0.001). According to these findings, the hypothalamic-pituitary-adrenal axis activity and anxiety levels of medical residents are higher on an ED-duty day than on a regular working day.
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14
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Georgiou K, Larentzakis A, Papavassiliou AG. Surgeons' and surgical trainees' acute stress in real operations or simulation: A systematic review. Surgeon 2017; 15:355-365. [PMID: 28716368 DOI: 10.1016/j.surge.2017.06.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/29/2017] [Accepted: 06/19/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute stress in surgery is ubiquitous and has an immediate impact on surgical performance and patient safety. Surgeons react with several coping strategies; however, they recognise the necessity of formal stress management training. Thus, stress assessment is a direct need. Surgical simulation is a validated standardised training milieu designed to replicate real-life situations. It replicates stress, prevents biases, and provides objective metrics. The complexity of stress mechanisms makes stress measurement difficult to quantify and interpret. This systematic review aims to identify studies that have used acute stress estimation measurements in surgeons or surgical trainees during real operations or surgical simulation, and to collectively present the rationale of these tools, with special emphasis in salivary markers. METHODS A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The 738 articles retrieved were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. RESULTS Thirty-three studies were included in this systematic review. The methods for acute stress assessment varied greatly among studies with the non-invasive techniques being the most commonly used. Subjective and objective tests for surgeons' acute stress assessment are being presented. CONCLUSION There is a broad spectrum of acute mental stress assessment tools in the surgical field and simulation and salivary biomarkers have recently gained popularity. There is a need to maintain a consistent methodology in future research, towards a deeper understanding of acute stress in the surgical field.
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Affiliation(s)
- Konstantinos Georgiou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens 11527, Greece.
| | - Andreas Larentzakis
- 1st Propaedeutic Surgical Clinic, Medical School, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Avenue, Athens 11527, Greece.
| | - Athanasios G Papavassiliou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens 11527, Greece.
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15
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Crewther BT, Shetty K, Jarchi D, Selvadurai S, Cook CJ, Leff DR, Darzi A, Yang GZ. Skill acquisition and stress adaptations following laparoscopic surgery training and detraining in novice surgeons. Surg Endosc 2015; 30:2961-8. [PMID: 26487239 DOI: 10.1007/s00464-015-4584-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical training and practice is stressful, but adaptive changes in the stress circuitry (e.g. perceptual, physiological, hormonal, neural) could support skill development. This work examined skill acquisition and stress adaptations in novice surgeons during laparoscopic surgery (LS) training and detraining. METHODS Twelve medical students were assessed for skill performance after 2 h (BASE), 5 h (MID) and 8 h (POST) of LS training in weeks 1-3, and then after 4 weeks of no training (RETEST). The stress outcomes included state anxiety, perceived stress and workload, heart rate (HR), heart rate variability (HRV), and salivary testosterone and cortisol concentrations. Functional near-infrared spectroscopy was used to assess cortical oxygenation change, as a marker of prefrontal cortex (PFC) activity. RESULTS Skill performance improved in every session from BASE (p < 0.01), with corresponding decreases in state anxiety, stress, workload, low- and high-frequency HRV in the MID, POST and/or RETEST sessions (p < 0.05). Left and right PFC were symmetrically activated within each testing session (p < 0.01). The stress and workload measures predicted skill performance and changes over time (p < 0.05), with state anxiety, mean HR and the HRV measures also showing some predictive potential (p < 0.10). CONCLUSIONS A 3-week LS training programme promoted stress-related adaptations likely to directly, or indirectly, support the acquisition of new surgical skills, and many outcomes were retained after a 4-week period without further LS training. These results have implications for medical training and education (e.g. distributed training for skill development and maintenance, stress resource and management training) and highlighted possible areas for new research (e.g. longitudinal stress and skill profiling).
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Affiliation(s)
- Blair T Crewther
- The Hamlyn Centre for Robotic Surgery, Imperial College, South Kensington Campus, London, UK.
| | - Kunal Shetty
- The Hamlyn Centre for Robotic Surgery, Imperial College, South Kensington Campus, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Delaram Jarchi
- The Hamlyn Centre for Robotic Surgery, Imperial College, South Kensington Campus, London, UK
| | | | - Christian J Cook
- The Hamlyn Centre for Robotic Surgery, Imperial College, South Kensington Campus, London, UK.,School of Sport, Health and Exercise Science, Bangor University, Bangor, UK
| | - Daniel R Leff
- The Hamlyn Centre for Robotic Surgery, Imperial College, South Kensington Campus, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College, South Kensington Campus, London, UK
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16
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Abstract
Image-guided surgery (IGS) is progressively used in endoscopic sinus surgery (ESS), and surgeon comfort with the technology has increased. It remains a challenge to determine if the use of IGS in ESS leads to a reduction in surgical complications and improved outcomes. Current literature does not show a clear reduction in surgical complications. The routine use of IGS in ESS as a deterrent to medicolegal liability is not substantiated by recent reported data. There are particular situations in which IGS may be helpful, but its use is likely not required for routine ESS and seems best left to surgeon discretion.
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Affiliation(s)
- Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, 12631 East 17th Avenue, B205, Aurora, CO 80045, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, 12631 East 17th Avenue, B205, Aurora, CO 80045, USA.
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17
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Marrelli M, Gentile S, Palmieri F, Paduano F, Tatullo M. Correlation between Surgeon's experience, surgery complexity and the alteration of stress related physiological parameters. PLoS One 2014; 9:e112444. [PMID: 25379944 PMCID: PMC4224481 DOI: 10.1371/journal.pone.0112444] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/15/2014] [Indexed: 01/16/2023] Open
Abstract
Introduction In the present work we analyzed the hormonal (salivary Cortisol; sC), immune (salivary Immunoglobulin A; sIgA) and cardiovascular (Heart rate, HR, and systolic blood pressure, SBP) responses induced by stress conditions in oral surgeons, randomly recruited according to their expertise level. Materials and methods Each surgeon performed three different surgical procedures with increasing degrees of technical difficulty and under time-limited conditions, to assess whether these variants may influence the risks of stress-induced secondary hypertension among the involved health professionals. sC and sIgA samples and cardiovascular function measurements were taken up before, during, and two hours after every surgery. Salivary samples and cardiovascular measurements were taken also during non-surgical days, as baseline controls. Results We observed that more experienced surgeons showed a higher stress management ability compared to those with less experience or, generally, younger, which are more exposed to the risks of developing secondary hypertension. Nevertheless, indipendently of sex and experience, oral surgeons are constantly exposed to high risks of developing stress-related diseases. Conclusions On the basis of the issues addressed and the results obtained, we have highlighted the importance of the investigated stress biomarkers to monitor and to prevent stress-related pathologies among oral surgeons. This approach is aimed to emphasize the significance of these specific stress-biomarkers, which represent a powerful instrument to evaluate stress levels in oral surgeons, and that may help to reduce the most severe life-threatening risks to which they are daily exposed. In conclusion, final goal of this study is to suggest an useful guideline to monitor the stress levels of oral and maxillofacial surgeons in order to improve their quality of life, which is inevitably reflected on the quality of the performances provided and, finally, to prevent possible mistakes in their daily activities.
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Affiliation(s)
- Massimo Marrelli
- Unit of Maxillofacial Surgery, Calabrodental, Crotone, Italy; Tecnologica Research Institute, Biomedical Section, Crotone, Italy
| | - Stefano Gentile
- Tecnologica Research Institute, Biomedical Section, Crotone, Italy
| | | | | | - Marco Tatullo
- Unit of Maxillofacial Surgery, Calabrodental, Crotone, Italy; Tecnologica Research Institute, Biomedical Section, Crotone, Italy
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18
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Theodoraki MN, Ledderose GJ, Becker S, Leunig A, Arpe S, Luz M, Stelter K. Mental distress and effort to engage an image-guided navigation system in the surgical training of endoscopic sinus surgery: a prospective, randomised clinical trial. Eur Arch Otorhinolaryngol 2014; 272:905-913. [PMID: 25007736 DOI: 10.1007/s00405-014-3194-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/01/2014] [Indexed: 11/25/2022]
Abstract
The use of image-guided navigation systems in the training of FESS is discussed controversy. Many experienced sinus surgeons report a better spatial orientation and an improved situational awareness intraoperatively. But many fear that the navigation system could be a disadvantage in the surgical training because of a higher mental demand and a possible loss of surgical skills. This clinical field study investigates mental and physical demands during transnasal surgery with and without the aid of a navigation system at an early stage in FESS training. Thirty-two endonasal sinus surgeries done by eight different trainee surgeons were included. After randomization, one side of each patient was operated by use of a navigation system, the other side without. During the whole surgery, the surgeons were connected to a biofeedback device measuring the heart rate, the heart rate variability, the respiratory frequency and the masticator EMG. Stress situations could be identified by an increase of the heart rate frequency and a decrease of the heart rate variability. The mental workload during a FESS procedure is high compared to the baseline before and after surgery. The mental workload level when using the navigation did not significantly differ from the side without using the navigation. Residents with more than 30 FESS procedures already done, showed a slightly decreased mental workload when using the navigation. An additional workload shift toward the navigation system could not be observed in any surgeon. Remarkable other stressors could be identified during this study: the behavior of the supervisor or the use of the 45° endoscope, other colleagues or students entering the theatre, poor vision due to bleeding and the preoperative waiting when measuring the baseline. The mental load of young surgeons in FESS surgery is tremendous. The application of a navigation system did not cause a higher mental workload or distress. The device showed a positive effort to engage for the trainees with more than 30 FESS procedures done. In this subgroup it even leads to decreased mental workload.
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Affiliation(s)
- M N Theodoraki
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulm, University Clinic of Ulm, Ulm, Germany.
| | - G J Ledderose
- Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
| | - S Becker
- Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
| | - A Leunig
- Clinics and Private Practice Dr. Gärtner, Munich, Germany
| | - S Arpe
- Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
| | - M Luz
- Industrial, Engineering and Organisational Psychology of the Technical University, Berlin, Germany
| | - K Stelter
- Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
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Stelter K, Theodoraki MN, Becker S, Tsekmistrenko V, Olzowy B, Ledderose G. Specific stressors in endonasal skull base surgery with and without navigation. Eur Arch Otorhinolaryngol 2014; 272:631-8. [PMID: 24972542 DOI: 10.1007/s00405-014-3154-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
The goal of modern organizational psychology is to recognize, anticipate and finally avoid stress situations. The aim of this study was to measure objectively the mental and physical demands during transnasal surgery with and without the aid of a navigation system. Forty endonasal surgeries (20 with and 20 without navigation, not blinded and not randomized) done by four different experienced rhinosurgeons (>250 FESS procedures done) were included. The heart rate, the heart rate variability, the respiratory frequency and the masseter tone were monitored as biometrical parameters by the surgeons during the whole surgery for the quantification of mental demand. Stress situations could be identified during the procedures by an increase in the heart rate and a decrease in the heart rate variability. Stress level in procedures with navigation did not significantly differ from procedures without navigation. Interestingly, in 10 % of the cases a navigation system would have been helpful, although the surgeon stated before the procedure that such a system would not be necessary. Other stressors could be identified like time pressure, students or colleagues speaking with the surgeon or chatting in the OR and system failure of medical devices, i.e. navigation, sinus drill, electrocautery or shaver. Surgical stressors blurred vision due to diffuse bleeding and drill out procedures in the sphenoid sinus. Calming situations were a quiet atmosphere in the OR (i.e. closed doors) and the participation of another experienced colleague, especially a neurosurgeon. Stress situations occur when complex medical devices like the navigation do not work. For their proper function it is important that the whole OR-team is trained with it. Unqualified or unmotivated OR personnel create stress for the surgeon and disharmony in the team, which then ends in inadequate behaviour.
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Affiliation(s)
- K Stelter
- Department of Otorhinolaryngology, Ludwig Maximilians University, Munich, Germany,
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20
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Luz M, Manzey D, Mueller S, Dietz A, Meixensberger J, Strauss G. Impact of navigated-control assistance on performance, workload and situation awareness of experienced surgeons performing a simulated mastoidectomy. Int J Med Robot 2013; 10:187-95. [PMID: 23955899 DOI: 10.1002/rcs.1527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/12/2013] [Accepted: 07/25/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Navigated control (NC) is an advanced image-guided navigation system that provides an additional control function to enhance patient safety. It automatically stops the surgical instrument if it comes close to critical anatomical structures that need to be protected during surgery. The purpose of this study was to explore the human performance consequences of computer-based navigated control assistance. METHODS Seven experienced surgeons conducted a simulated mastoidectomy manually and with support of the NC system. The impact on surgical performance, workload and situation awareness was analysed. RESULTS NC support led to a better quality of surgical outcome and a lower level of physiological effort during surgery. Cost effects were reflected in reduced time efficiency and an increased subjectively experienced workload. CONCLUSION The results demonstrate the potential of NC support in terms of lower workload and enhanced patient safety. Cost effects might be reduced by remodelling the control function.
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Affiliation(s)
- M Luz
- Technische Universität Berlin (TUB), Institute of Psychology and Ergonomics, Berlin, Germany
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