Skip to main content
Springer Nature Link
Log in

Three different types of surgeon-specific stress reactions identified by laparoscopic simulation in a virtual scenario

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Minimally invasive surgery causes higher mental strain for surgeons than conventional surgery and is significantly more stressful in consecutive cases. This study aimed to investigate whether individual stress responses are associated with intraoperative alterations of manual surgical skills and technical errors of the laparoscopic surgeon.

Methods

The LapSim virtual reality simulator was used. Stress measurement was carried out for 18 surgeons performing a virtual cholecystectomy using the LapSim simulator in the context of the patient simulator provided by the METI Corporation. In the course of the study, the surgeons were exposed to different external stressors (S1–S4) in defined intervals. The activity of the sympathetic nervous system was evaluated by skin resistance with the help of a sympathicograph.

Results

Three different surgeon-specific stress reactions (SSR) could be identified. The first, SSR-1, with significant stress reactions during the study without recovery, showed larger laparoscopic extensions of movement but fewer intraoperative complications than SSR-2 (recovery after the stress reactions) or SSR-3 (without significant stress reactions).

Conclusions

The mental load of the laparoscopic surgeon might be highly optimized by continuous activity of the sympathetic nervous system. The question of what extent or quality of stress produces adverse effects remains unclear.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Berguer R, Smith WD, Chung YH (2001) Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc 15:1204–1207

    Article  PubMed  CAS  Google Scholar 

  2. Bohm B, Rotting N, Schwenk W, Grebe S, Mansmann U (2001) A prospective randomized trial on heart rate variability of the surgical team during laparoscopic and conventional sigmoid resection. Arch Surg 136:305–310

    Article  PubMed  CAS  Google Scholar 

  3. Czyzewska E, Kiczka K, Czarnecki A, Pokinko P (1983) The surgeon’s mental load during decision making at various stages of operations. Eur J Appl Physiol 51:441–446

    Article  CAS  Google Scholar 

  4. Eastridge BJ, Hamilton EC, O’Keefe GE, Rege RV, Valentine RJ, Jones DJ, Tesfay S, Thal ER (2003) Effect of sleep deprivation on the performance of simulated laparoscopic surgical skills. Am J Surg 186:169–174

    Article  PubMed  Google Scholar 

  5. Hassan I, Weyers P, Maschuw K, Dick B, Gerdes B, Rothmund M, Zielke A (2006) Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance. Br J Surg 93:1554–1559

    Article  PubMed  CAS  Google Scholar 

  6. Janitzki A, Götte A (1986) Hautwiderstandsmessungen zum Aktivitätsnachweis des Sympathicus bei der Spinalanästhesie. Regional-Anästhesie 9:49–53

    CAS  Google Scholar 

  7. Jensen A, Milner R, Fisher C, Gaughan J, Rolandelli R, Grewal H (2004) Short-term sleep deficits do not adversely affect acquisition of laparoscopic skills in a laboratory setting. Surg Endosc 18:948–953

    Article  PubMed  CAS  Google Scholar 

  8. McCraty R, Atkinson M, Tiller WA, Rein G, Watkins AD (1995) The effects of emotions on short-term power spectrum analysis of heart rate variability. Am J Cardiol 76:1089–1093

    Article  PubMed  CAS  Google Scholar 

  9. Moorthy K, Munz Y, Dosis A, Bann S, Darzi A (2003) The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc 17:1481–1484

    Article  PubMed  CAS  Google Scholar 

  10. Moorthy K, Munz Y, Forrest D, Pandey V, Undre S, Vincent C, Darzi A (2006) Surgical crisis management skills training and assessment: a simulation-based approach to enhancing operating room performance. Ann Surg 244:139–147

    Article  PubMed  Google Scholar 

  11. Muller M (2004) Safety lessons taken from the airlines. Br J Surg 91:393–394

    Article  PubMed  CAS  Google Scholar 

  12. Pagani M, Furlan R, Pizzinelli P, Crivellaro W, Cerutti S, Malliani A (1989) Spectral analysis of R-R and arterial pressure variabilities to assess sympatho-vagal interactions during mental stress in humans. Hypertension 7:14–15

    Google Scholar 

  13. Wetzel CM, Kneebone RL, Woloshynowych M, Nestel D, Moorthy K, Kidd J, Darzi A (2006) The effects of stress on surgical performance. Am J Surg 191:5–10

    Article  PubMed  Google Scholar 

  14. Woodrum DT, Andreatta PB, Yellamanchilli RK, Feryus L, Gauger PG, Minter RM (2006) Construct validity of the LapSim laparoscopic surgical simulator. Am J Surg 191:28–32

    Article  PubMed  Google Scholar 

  15. Yule S (2005) Critical thinking: nontechnical skills in surgery. Surgeon’s News 3:75–76

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesiology, Simulation Center, Johannes Gutenberg–University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    M. Schuetz, P. Hakman, S. Moenk & W. Heinrichs

  2. Department of General and Abdominal Surgery, Johannes Gutenberg–University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    I. Gockel, F. Dunschede & Th. Junginger

  3. Department of Trauma Surgery, Johannes Gutenberg–University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    J. Beardi

Authors
  1. M. Schuetz
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. I. Gockel
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. J. Beardi
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. P. Hakman
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. F. Dunschede
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. S. Moenk
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. W. Heinrichs
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Th. Junginger
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to I. Gockel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schuetz, M., Gockel, I., Beardi, J. et al. Three different types of surgeon-specific stress reactions identified by laparoscopic simulation in a virtual scenario. Surg Endosc 22, 1263–1267 (2008). https://doi.org/10.1007/s00464-007-9605-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-007-9605-1

Keywords