1
|
Ito Y, Hafez A, Hosoo H, Marushima A, Matsumaru Y, Ishikawa E. Effect of Sleep Deprivation on Simulated Microsurgical Vascular Anastomosis. J Neurol Surg A Cent Eur Neurosurg 2024; 85:389-395. [PMID: 37023791 DOI: 10.1055/a-2070-4716] [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] [Indexed: 04/08/2023]
Abstract
BACKGROUND The effects of sleep deprivation on surgical performance have been well documented. However, reports on the effects of sleep deprivation on microneurosurgery are limited. This study aimed to investigate the effects of sleep deprivation on microneurosurgery. METHODS Ten neurosurgeons participated in the anastomosis of a vessel model using a microscope in sleep-deprived and normal states. We evaluated the procedure time (PT), stitch time (ST), interval time (IT), number of unachieved movements (NUM), leak rate, and practical scale for anastomosis quality assessment. Each parameter was compared between normal and sleep-deprived states. Subanalyses were performed on the two groups based on PT and NUM under the normal state (proficient and nonproficient groups). RESULTS Although no significant differences were noted in PT, ST, NUM, leak rate, or practical scale, IT was significantly prolonged under sleep deprivation compared with the normal state (mean: 258.8 ± 94.0 vs. 199.3 ± 74.9 seconds; p = 0.02). IT was significantly prolonged under sleep deprivation in the nonproficient group based on both PT and NUM (PT: 234.2 ± 71.6 vs. 321.2 ± 44.7 seconds, p = 0.04; NUM: 173.3 ± 73.6 vs. 218.7 ± 97.7; p = 0.02), whereas no significant difference was observed in the proficient group (PT: 147.0 ± 47.0 vs. 165.3 ± 61.1 seconds, p = 0.25; NUM: 173.3 ± 73.6 vs. 218.7 ± 97.7; p = 0.25). CONCLUSIONS Although IT was significantly prolonged under sleep deprivation in the nonproficient group, there was no decline in performance skills in either the proficient or nonproficient group. The effect of sleep deprivation may require caution in the nonproficient group, but it is possible that certain microneurosurgical outcomes can be achieved under sleep deprivation.
Collapse
Affiliation(s)
- Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
2
|
Lee A, Torkamani-Azar M, Zheng B, Bednarik R. Unpacking the Broad Landscape of Intraoperative Stressors for Clinical Personnel: A Mixed-Methods Systematic Review. J Multidiscip Healthc 2023; 16:1953-1977. [PMID: 37484819 PMCID: PMC10361288 DOI: 10.2147/jmdh.s401325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose The main goals of this mixed-methods systematic review are to identify what types of intraoperative stressors for operating room personnel have been reported in collected studies and examine the characteristics of each intraoperative stressor. Methods With a systematic literature search, we retrieved empirical studies examining intraoperative stress published between 2010 and 2020. To synthesize findings, we applied two approaches. First, a textual narrative synthesis was employed to summarize key study information of the selected studies by focusing on surgical platforms and study participants. Second, a thematic synthesis was employed to identify and characterize intraoperative stressors and their subtypes. Results Ninety-four studies were included in the review. Regarding the surgical platforms, the selected studies mainly focused on minimally invasive surgery and few studies examined issues around robotic surgery. Most studies examined intra-operative stress from surgeons' perspectives but rarely considered other clinical personnel such as nurses and anesthetists. Among seven identified stressors, technical factors were the most frequently examined followed by individual, operating room environmental, interpersonal, temporal, patient, and organizational factors. Conclusion By presenting stressors as multifaceted elements affecting collaboration and interaction between multidisciplinary team members in the operating room, we discuss the potential interactions between stressors which should be further investigated to build a safe and efficient environment for operating room personnel.
Collapse
Affiliation(s)
- Ahreum Lee
- Samsung Electronics Co. Ltd., Suwon, Gyeonggi-do, Republic of Korea
| | | | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
3
|
Effect of Background Music in the Operating Room on Surgical Outcomes: A Prospective Single-Blinded Case-Control Study. J Am Coll Surg 2022; 235:447-453. [PMID: 35972164 DOI: 10.1097/xcs.0000000000000279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of playing background music on surgical outcomes has been controversial. This prospective case-control study aims to evaluate the impact of music tempo in general surgical settings. STUDY DESIGN Six hundred consecutive patients with nonmetastatic breast cancer receiving breast cancer surgery have been recruited since April 2017. Patients were then assigned to 3 arms in consecutive order. The surgeon operated without music in study arm A; the surgeon operated with slow music in study arm B; and in study arm C, the surgeon operated with fast background music. Patients' clinical records were reviewed by an independent blinded assessor. RESULTS Baseline demographic data were comparable among the 3 study arms. Seven (3.5%) patients from study arm A developed minor complications (Clavien-Dindo class I and II); none developed major complications (Clavien-Dindo class III or above). Six (3.0%) patients from study arm B and C, respectively (slow/fast music groups), developed minor complications; none developed a major complication. Mean blood loss was also similar among the 3 study arms (5.1, 5.1, and 5.2 mL, respectively; p > 0.05). Operating time was significantly shorter in study arm C: 115 minutes (90-145), compared with 125 minutes (100-160) in study arm A (p < 0.0001) and 120 minutes (95-155) in study arm B (p = 0.0024). After a median follow-up of 40 months (3-56), 40 months (3-56), and 39.5 months (3-56), the local recurrence rates were 1.5%, 1%, and 1%, respectively (p > 0.05). CONCLUSION Playing music in the operating room is safe in general surgical settings in experienced hands.
Collapse
|
4
|
Effects of Meditation for Surgeons: A Systematic Review of the Scientific Literature. Ann Surg 2022; 275:1074-1077. [PMID: 35081577 DOI: 10.1097/sla.0000000000005398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review the available evidence about meditation's effects on surgeons. SUMMARY BACKGROUND DATA Meditation and Mindfulness are positively associated with better mental health and performance in different types of workers and professionals needing high levels of concentration. Surgery is one of the activities with the greatest need for high concentration.Even though these findings are supported by a number of studies, evidence is lacking on the effect of meditation on surgeons. METHODS We searched PubMed for meditation-related studies that focused on surgeons. A total of 243 articles were retrieved and after screening 8 were selected for data extraction. Four of these studies were pilot studies; 3 of them were randomized controlled trials. RESULTS Meditation was found to be beneficial for surgeons. Benefits span from motor skills to mental and physiological improvements. CONCLUSION More awareness and attention on this subject could improve surgeons' well-being as well as patients' outcomes.
Collapse
|
5
|
Peterson JL, Moore GE, Risselada M. Influence of musical preferences and intraoperative questions on suturing speed. Vet Surg 2021; 50:1617-1623. [PMID: 34569638 DOI: 10.1111/vsu.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/10/2021] [Accepted: 09/07/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the effect of music and surgeon-directed questions on suturing speed. STUDY DESIGN Randomized observational study. SAMPLE POPULATION Fifty-five faculty veterinarians, residents, interns, and fourth-year veterinary students. METHODS Experience, gender, and favorable and unfavorable music choices were self-declared by participants. Each person performed four timed suture trials, which required them to complete a simple 10 cm continuous suture pattern on a model. The initial trial served as practice and did not include music or questions. The order of the three remaining trials was randomized, and consisted of one trial each with favorable music, unfavorable music, and required the participant to answer 2 questions. Trial duration was compared using a mixed effects linear model. Influence of gender and experience on participants' categorical responses to 2 different questions was evaluated using a Pearson χ2 test and Fisher's exact test, respectively. Stratified analysis was used to evaluate further the effect of experience and gender. RESULTS Question trials were on average 8.1 s longer than favorable music trials (P = .008), with no notable difference found between unfavorable and favorable music or unfavorable music and question trials. Experience (P = .021) and gender (P = .033) influenced participants' response to question 1 but not question 2 (P = .267 and P = .839, respectively). CONCLUSION Listening to favorable music, rather than answering questions, may result in decreased closure times. This influence was greater for less experienced individuals and less experienced male veterinarians and veterinary students. CLINICAL SIGNIFICANCE The absence of questions may increase suturing speed, particularly for minimally experienced surgeons or when instruction is taking place in a surgical laboratory setting.
Collapse
Affiliation(s)
- Jennifer L Peterson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - George E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| |
Collapse
|
6
|
Hardie J, Oeppen R, Shaw G, Holden C, Tayler N, Brennan P. You Have Control: aviation communication application for safety-critical times in surgery. Br J Oral Maxillofac Surg 2020; 58:1073-1077. [PMID: 32933788 PMCID: PMC7449978 DOI: 10.1016/j.bjoms.2020.08.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 12/26/2022]
Abstract
High-risk organisations (HRO), including aviation, undergo formal communication training, with emphasis on safety-critical moments. Such training is not widespread or mandatory in healthcare, and while there are many differences both share the 'human element' with circumstances leading to an increased risk of harm. A typical operating theatre consists of an operating surgeon, and an assisting surgeon, roles that may change throughout the course of a procedure. Similarly, a training aircraft or multi-crew cockpit (flight deck) has a pilot in control, or 'pilot flying', and a 'pilot not flying'. Both interact with wider teams, for example the scrub team and air traffic controllers, respectively. Surgical error is the second most prevalent cause of preventable harm to patients after drug errors. Every year in the UK National Health Service (NHS), there are typically 500 never events, 21,000 serious incidents, and many more episodes of physical or psychological harm. Ineffective communication (46%) is the most common behavioural factor leading to a never event. In this review, we examine the concept of 'sterile cockpit', use of unambiguous terminology, callsigns, important information readback, sharing of mental models, and the mini-brief, and how these may be used to reduce patient harm during safety-critical moments.
Collapse
Affiliation(s)
- J.A. Hardie
- Trauma & Orthopaedic Department, Frimley Park Hospital, Camberley, GU16 7UJ, UK,Corresponding author
| | - R.S. Oeppen
- Department of Clinical Radiology, University Hospitals Southampton, SO16 6YD, UK
| | - G. Shaw
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - C. Holden
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - N. Tayler
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - P.A. Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| |
Collapse
|
7
|
Abecassis IJ, Sen RD, Ellenbogen RG, Sekhar LN. Developing microsurgical milestones for psychomotor skills in neurological surgery residents as an adjunct to operative training: the home microsurgery laboratory. J Neurosurg 2020; 135:194-204. [PMID: 32886917 DOI: 10.3171/2020.5.jns201590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A variety of factors contribute to an increasingly challenging environment for neurological surgery residents to develop psychomotor skills in microsurgical technique solely from operative training. While adjunct training modalities such as cadaver dissection and surgical simulation are embraced and practiced at our institution, there are no formal educational milestones defined to help residents develop, measure, and advance their microsurgical psychomotor skills in a stepwise fashion when outside the hospital environment. The objective of this report is to describe an efficient and convenient "home microsurgery lab" (HML) assembled and tested by the authors with the goal of supporting a personalized stepwise advancement of microsurgical psychomotor skills. METHODS The authors reviewed the literature on previously published simulation practice models and designed adjunct learning modules utilizing the HML. Five milestones were developed for achieving proficiency with each graduated exercise, referencing the Accreditation Council for Graduate Medical Education (ACGME) guidelines. The HML setup was then piloted with 2 neurosurgical trainees. RESULTS The total cost for assembling the HML was approximately $850. Techniques for which training was provided included microinstrument handling, tissue dissection, suturing, and microanastomoses. Five designated competency levels were developed, and training exercises were proposed for each competency level. CONCLUSIONS The HML offers a unique, entirely home-based, affordable adjunct to the operative neurosurgical education mandated by the ACGME operative case logs, while respecting resident hospital-based education hours. The HML provides surgical simulation with specific milestones, which may improve confidence and the microsurgical psychomotor skills required to perform microsurgery, regardless of case type.
Collapse
|
8
|
Hafez A, Elsharkawy A, Schwartz C, Muhammad S, Laakso A, Niemelä M, Lehecka M. Comparison of Conventional Microscopic and Exoscopic Experimental Bypass Anastomosis: A Technical Analysis. World Neurosurg 2019; 135:e293-e299. [PMID: 31805406 DOI: 10.1016/j.wneu.2019.11.154] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, the use of digital exoscopes has been increasingly promoted as an alternative to microscopes. The aim of this study is to compare experimental bypass quality in both visualization methods. METHODS This study used two hundred 1-mm chicken wing vessels, which were used for either exoscopic or microscopic (100 samples each) bypass procedures. All procedures were recorded between July 2018 and September 2018. The bypass quality was evaluated according to our published practical scale (time, stitch distribution, intima-intima attachment, and orifice size). RESULTS Both methods are effective in doing bypass suturing (practical scale score was good, 86% vs. 85%; P = 0.84). There were no significant differences regarding intima-intima attachment (P = 0.26) and orifice size (P = 0.25). However, suturing time (P < 0.001) was less using the microscope, whereas stitch distribution (P = 0.001) was better using the exoscope. Different suturing techniques (interrupted vs. continuous) had overall comparable results (P = 0.55). CONCLUSIONS Both methods produced equally satisfactory results in experimental bypass procedures. The exoscope has the potential for better 3-dimensional visualization and sharing the surgeon's view with others for teaching purposes.
Collapse
Affiliation(s)
- Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
| | - Ahmed Elsharkawy
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Tanta University, Tanta, Egypt
| | - Christoph Schwartz
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria
| | - Sajjad Muhammad
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|