Surgeons’ Biological Stress Responses During Fundamentals of Laparoscopic Surgery Exercises: A Descriptive Study

STUDY OBJECTIVE: Adverse surgeon stress can contribute to poor non-technical skills and burnout, impacting surgical performance and patient outcomes. Identifying surgical stressors is key to improving surgeons' and patients' wellbeing. We aim to describe biological measures of surgeon stress during laparoscopic exercises. DESIGN: Prospective Cohort SETTING: Simulated laparoscopic exercises were completed in an isolated research setting. PATIENTS: 26 Surgeon volunteers. INTERVENTIONS: Participants completed peg transfer, pattern cutting, and intra-corporal knot exercises from the fundamental laparoscopic skills curriculum in neutral and stressed (ergonomic, time pressure, or noise) conditions. Measures of cortisol, heart rate (HR), and heart rate variability (HRV) were recorded at baseline and during simulation, and NASA task load Index post simulation. MEASUREMENTS AND MAIN RESULTS: 26 surgeons participated, with a wide variation in biological response to laparoscopic exercises. Surgeons' mean scores from baseline decreased for cortisol (10.1 vs 7.2 nmol/L), increased for mean and maximum heart rate (79.2 vs 88.6 bpm; 95.8 vs 109.0 bpm), and were unchanged for HRV. Proportionally, 22% of surgeon-simulations recorded increased cortisol, 79% increased maximum HR, 42% increased HRV low-frequency to high-frequency ratio, and 70% increased HRV standard deviation of beat-to-beat. Mean HR was higher during "neutral" exercises relative to "stressed" exercises, however, a greater proportion of HRV measures were higher in "stressed" exercises. Changes in HR were not significantly correlated with physical dimensions of NASA task load index. CONCLUSION: This study demonstrates that current biological measures are widely variable within and between individuals. Overall, the discriminatory capacity of these measures for stress detection and tracking when using pooled means is poor.