Relax, It's Just Laparoscopy! A Prospective Randomized Trial on Heart Rate Variability of the Surgeon in Robot-Assisted versus Conventional Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic surgery might be beneficial for the patient, but it imposes increased physical and mental strain on the surgeon. Robot-assisted laparoscopic surgery addresses some of the laparoscopic drawbacks and may potentially reduce mental strain. This could reduce the risk of surgeon's fatigue, mishaps and strain-induced illnesses, which may eventually improve the safety of laparoscopic surgical procedures. Methods: To test this hypothesis, a randomized study was performed, comparing both heart rate and heart rate variability (HRV) of the surgeon as a measure of total and mental strain, respectively, during conventional and robot-assisted laparoscopic cholecystectomy. Results: Both heart rate and HRV (the low-frequency band/high-frequency band ratio) were significantly decreased when using robotic assistance. Conclusions: These data suggest the use of the daVinci® Surgical System leads to less physical and mental strain of the surgeon during surgery. However, assessing mental strain by means of HRV is cumbersome since there is no clear cutoff point or scale for maximum tolerated strain levels and its related effects on surgeon's health.

Robotic Rectal Cancer Resection: A Retrospective Multicenter Analysis

“…The use of robotics for the treatment of rectal cancer is a feasible approach, with potential advantages in the narrow pelvis when compared with open surgery and conventional laparoscopy. 9,18,[20][21][22][23][24][25][26]34 To the best of our knowledge, this multicenter series represents the largest number of roboticassisted rectal cancer resections with TME or PME to date. This study was specifically designed to review the data of multiple surgeons practicing in different clinical settings and with different degrees of experience.…”

“…Robotic surgery provides several advantages, namely three-dimensional visualization, articulated instrumentation, and a stable camera platform, which all lead to improved surgical ergonomics and cognitive and physical stress reduction. [19][20][21] It allows the surgeon to regain the two lost degrees of freedom by introducing wristed instruments. The value of using six degrees of freedom becomes most evident in complex surgical procedures, particularly if performed within a confined space such as the pelvis.…”

“…The value of using six degrees of freedom becomes most evident in complex surgical procedures, particularly if performed within a confined space such as the pelvis. [18][19][20][21][22] Several studies report excellent oncological and clinical outcomes for robotic rectal surgery, with potential advantages over conventional laparoscopy and open surgery. [23][24][25][26][27][28][29] The aim of this study was to evaluate the feasibility, oncologic safety, and short-term outcomes of robotic rectal cancer resection in a large series collected from multiple institutions and surgeons.…”

Expert consensus on robotic surgery for colorectal cancer (2015 edition)

“…The system enables the surgeon to perform with dexterity and with very deliberate motion control of the instruments to pursue precise surgical tasks. Sitting at the surgeon console, the surgeon can control the movement of the patient cart precisely and seamlessly and also avoid standing for long periods during surgery, reducing physiological fatigue [ 1 – 3 ]. Moreover, the master controllers provide tremor filtration to stabilize the surgical procedure.…”

Roboterassistierte Rektumkarzinomchirurgie

“…Positiv ist zudem der deutliche ergonomische Vorteil für den Chirurgen selbst. Hier scheinen roboterassistierte Verfahren der Laparoskopie deutlich überlegen zu sein[29][30][31]. Lena Jakubzik, Ronny Otto, Carl Meißner und Martina Bergner für ihre Hilfe bei der Erfassung und Auswertung der Datensätze.Interessenkonflikt: B. Mann ist als Proctor für Intuitive Surgical ® tätig.…”