SOS save our surgeons: Stress levels reduced by robotic surgery

Abstract

Robotic-assisted laparoscopic surgery (RALS) is making an increasingly significant contribution to the field of gynaecological surgery. RALS offers similar patient benefits to standard laparoscopic surgery (SLS) with a potentially more ergonomically friendly and less stressful environment for the surgeon. However, our understanding of how RALS may potentially reduce physiological stress on the surgeon is currently limited. To assess how performing surgical tasks using RALS in comparison to SLS impacts on hypothalamic pituitary adrenal (HPA) axis function and sympathetic nervous system (SNS) activity, two key indicators of the physiological stress response. This study is an analytical, within subjects, crossover design study. Sixteen surgically inexperienced medical students performed tasks with both SLS and RALS instrumentation. Blood pressure (BP) was taken before and after task performance. Skin conductance level (SCL), heart rate (HR) and HR variability (HRV) were measured continuously during task performance. Pre-and post-task saliva samples were collected to determine cortisol levels using ELISA. SCL was significantly lower during RALS in comparison to SLS task performance (p<0.05). HR was significantly lower during RALS vs. SLS tasks (p<0.01). Both HRV measures were significantly higher during RALS vs. SLS tasks (p<0.01). Cortisol levels and BP were lower during RALS vs. SLS but did not reach statistical significance (p=0.73 and p=0.22, respectively). Stress can impair surgeon's technical and nontechnical skills. These results indicate that the improved ergonomic setup of RALS has a beneficial impact on physiological indicators of stress. This also demonstrates the potential of RALS to reduce the negative effects of long-term stress exposure on the surgeon.

Laparoscopic versus robotic-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review

“…In a nutshell, this study showed that RASC was associated with lower neck, shoulder, and back discomfort scores [ 35 ]. Stress levels, measured by skin conductance level, and heart rate were significantly lower in surgically inexperienced medical students performing tasks with the robot when compared to laparoscopic instrumentation [ 37 ]. These findings will need to be validated in a proper RCT and a more homogenous population of surgeons.…”

Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics

“…The normalized GSR average value was found to be the most relevant parameter in terms of its relationship with stress, with an increase of 261% between the baseline and stressful phases of the experiment and a high, significantly positive correlation with the subjective stress rating that was stated by the participants. The relevance of the GSR average values has already been demonstrated in the literature and appears as one of the trending parameters for measuring stress in surgical environments [ 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ].…”

“…The most popular approaches are mainly descriptive (i.e., the mean, standard deviation and sum of the GSR signal). For instance, Hurley et al [ 62 ] used these metrics to find the differences in the stress levels between standard laparoscopic surgery and robotic surgery. These metrics have also been used to validate their relation with other variables, specifically with workload [ 63 ] and performance [ 64 ].…”

Quality of laparoscopic camera navigation in robot‐assisted versus conventional laparoscopic surgery for rectal cancer: An analysis of surgical videos through a video processing computer software

“…This self‐tolerance for suboptimal centred view in RALS might be consequent to full ownership of the surgical procedure by the robotic surgeon, with no need for coordination with the assistant. This also could explain the lower surgeon stress during RALS compared to CLS 17 . However, it is not possible to estimate retrospectively to what degree a well‐centred view was achieved based on verbal and manual corrections from the surgeon during CLS.…”