The impact of operating room noise levels on stress and work efficiency of the operating room team: A protocol for systematic review and meta-analysis

Artificial Intelligence-Driven Approaches to Managing Surgeon Fatigue and Improving Performance

Surgeon fatigue significantly affects cognitive and motor functions, increasing the risk of errors and adverse patient outcomes. Traditional fatigue management methods, such as structured breaks and duty-hour limits, are insufficient for real-time fatigue detection in high-stakes surgeries. With advancements in artificial intelligence (AI), there is growing potential for AI-driven technologies to address this issue through continuous monitoring and adaptive interventions. This paper explores how AI, via machine learning algorithms, wearable devices, and real-time feedback systems, enables comprehensive fatigue detection by analysing physiological, behavioural, and environmental data. Techniques such as heart rate variability analysis, electroencephalogram monitoring, and computer vision-based behavioural analysis are examined, as well as predictive models that provide proactive solutions. These AI-driven systems could suggest personalized break schedules, task redistribution, and interface adaptations in response to real-time fatigue indicators, potentially enhancing surgical safety and precision. However, ethical challenges, including data privacy and surgeon autonomy, must be carefully navigated to foster acceptance and integration within clinical settings. This review highlights AI's transformative potential in optimizing fatigue management and improving overall outcomes in the operating room​​​​​.

Cologne ergonomic measurement for robotic surgery (CEMRobSurg) using the Hugo™ RAS System

BACKGROUND

The ergonomic advantages and potential challenges that robotic surgery poses to the well-being of surgeons are mainly unexplored. The most recent surgical robot introduced on the European market is the Hugo™ RAS System by Medtronic. This study aims to evaluate the ergonomic benefits of the Hugo™ RAS System, which is available in our training laboratory, CeMIT (Center for Medical Innovation and Technology Cologne).

METHODS AND PROCEDURES

Using the previously established Cologne Ergonomic Measurement Setup for Robotic Surgery (CEMRobSurg), we measured three parameters related to ergonomic posture from subjects with different levels of surgical expertise (laypeople, medical students, surgical residents, and expert robotic surgeons). The heart rate was measured continuously using a polar band. The noise level was measured while using the Hugo™ RAS System, and automated photographs using our locally developed methodology were captured of the participant every 2 s to assess body posture. The ergonomic measurements were conducted while the subject performed the same standardized robotic training exercises (Peg Board, Rope Walk, and Ring Walk).

RESULTS

A total of 53 participants were enrolled in this study. The average noise level during all measurements was 54.87 dB. The highest stress level was measured in surgical residents with a sympathetic nervous system index (SNS index) of 1.15 (min - 1.43, max 3.56). The lowest stress level was measured in robotic experts with an SNS index of 0.23 (min - 0.18, max 0.91). We observed a risk-prone positioning of the neck and elbow in medical students (mean 39.6° and 129.48°, respectively). Robotic experts showed a risk positioning in the knee and hip region (mean 107.89° and 90.31°, respectively).

CONCLUSION

This is the first study to analyze and objectify the ergonomic posture of medical students, surgical trainees, surgeons, and laypeople using the open console, modular Hugo™ RAS System. Our findings offer recommendations for operating surgeons and allow for a comparative analysis between the different robotic systems. Further evaluations in real-time operative scenarios will follow.

Noise in the operating room coincides with surgical difficulty

BACKGROUND

Noise in the operating room has been shown to distract the surgical team and to be associated with postoperative complications. It is, however, unclear whether complications after noisy operations are the result of objective or subjective surgical difficulty or the consequence of distraction of the operating room team by noise.

METHODS

Noise level measurements were prospectively performed during operations in four Swiss hospitals. Objective difficulty for each operation was calculated based on surgical magnitude as suggested by the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), duration of operation and surgical approach. Subjective difficulty and distraction were evaluated by a questionnaire filled out by the operating room team members. Complications were assessed 30 days after surgery. Using regression analyses, the relationship between objective and subjective difficulty, distraction, intraoperative noise and postoperative complications was tested.

RESULTS

Postoperative complications occurred after 121 (38%) of the 294 procedures included. Noise levels were significantly higher in operations that were objectively and subjectively more difficult (59.89 versus 58.35 dB(A), P < 0.001) and operations that resulted in postoperative complications (59.05 versus 58.77 dB(A), P = 0.004). Multivariable regression analyses revealed that subjective difficulty as reported by all members of the surgical team, but not distraction, was highly associated with noise and complications. Only objective surgical difficulty independently predicted noise and postoperative complications.

CONCLUSION

Noise in the operating room is a surrogate of surgical difficulty and thereby predicts postoperative complications.

Leading Through Noise: Operating Room Noise Challenges for Staff and Leadership Techniques to Ensure Optimal Operational Performance

Noise and distractions in the operating room (OR) critically impact surgical performance and patient outcomes, particularly in high-stakes environments such as trauma surgery. While historical hospital environments prioritized quiet to facilitate recovery and reduce stress, contemporary ORs, especially those handling trauma cases, face increasing noise challenges due to advanced surgical instruments, alarms, and staff conversations, often surpassing federal exposure limits. This review investigates OR noise sources, including staff activities and equipment, analyzing their effects on cognitive load, communication, and error rates among healthcare workers. It identifies high-risk scenarios and vulnerable groups, highlighting the necessity for targeted interventions. Key strategies include implementing strict noise control policies, using noise-reducing materials in OR design, and educating staff on noise impacts. Additionally, structured communication protocols and continuous monitoring systems are advocated to enhance operational efficiency and safety. Surgeon leadership is pivotal in balancing assertiveness and empathy to maintain a productive team dynamic. Furthermore, surgeons significantly boost OR efficiency and safety by adopting these protocols, promoting inclusive team dynamics, and applying noise-reduction strategies. These practices safeguard patient care and foster a more collaborative work atmosphere, aligning all team efforts toward optimal patient outcomes. This holistic approach emphasizes the need for continuous improvement and adaptability in surgical practices to meet modern healthcare demands, particularly in trauma surgery's fast-paced, unpredictable realm. Collectively, these measures can enhance patient safety and improve conditions for surgical teams, providing a framework for quieter, more focused OR environments that ultimately elevate surgical outcomes and healthcare quality.

The Effect of Sound in the Dental Office: Practices and Recommendations for Quality Assurance-A Narrative Review

Sound is inextricably linked to the human senses and is therefore directly related to the general health of the individual. The aim of the present study is to collect data on the effect of two dimensions of sound, music, and noise from an emotional and functional point of view in the dental office and to perform a thorough review of the relevant literature. We collected articles from the databases PubMed and Google Scholar through keywords that were related to noise and music in healthcare. Important information was also extracted from articles on the web and official websites. Screening of the relevant literature was performed according to accuracy and reliability of the methodology tested. A total of 261 articles were associated to sound and music in healthcare. Ninety-six of them were the most well documented and were thus included in our article. Most of the articles associate noise with negative emotions and a negative impact on performance, while music is associated with positive emotions ranging from emotional state to therapeutic approaches. Few results were found regarding ways to reduce noise in a health facility. If there is a difficulty to find effective methods of reducing the daily noise-inducing sounds in the dental office, we must focus on ways to incorporate music into it as a means of relaxation and therapy.