Short-term clinical stressors during a laparoscopic training task significantly worsened kinematic markers (velocity, acceleration, jerk, path length) and objective evaluation scores.
RCT (n=30)
randomly assigned
Does exposure to short-term clinical stressors impair laparoscopic performance as measured by kinematic markers in surgical subjects?
Time-series kinematic data can objectively identify stressful conditions during laparoscopic surgery, potentially informing future robot-assisted algorithms to mitigate stress-induced performance decrements.
Increased levels of stress can impair surgeon performance and patient safety during surgery. The aim of this study is to investigate the effect of short term stressors on laparoscopic performance through analysis of kinematic data. Thirty subjects were randomly assigned into two groups in this IRB-approved study. The control group was required to finish an extended-duration peg transfer task (6 minutes) using the FLS trainer while listening to normal simulated vital signs and while being observed by a silent moderator. The stressed group finished the same task but listened to a period of progressively deteriorating simulated patient vitals, as well as critical verbal feedback from the moderator, which culminated in 30 seconds of cardiac arrest and expiration of the simulated patient. For all subjects, video and position data using electromagnetic trackers mounted on the handles of the laparoscopic instruments were recorded. A statistical analysis comparing time-series velocity, acceleration, and jerk data, as well as path length and economy of volume was conducted. Clinical stressors lead to significantly higher velocity, acceleration, jerk, and path length as well as lower economy of volume. An objective evaluation score using a modified OSATS technique was also significantly worse for the stressed group than the control group. This study shows the potential feasibility and advantages of using the time-series kinematic data to identify the stressful conditions during laparoscopic surgery in near-real-time. This data could be useful in the design of future robot-assisted algorithms to reduce the unwanted effects of stress on surgical performance.
Zheng et al. (Wed,) conducted a rct in Surgical training / laparoscopic performance (n=30). Short-term clinical stressors (deteriorating vitals and critical feedback) vs. Normal simulated vital signs and silent moderator was evaluated on Kinematic data (velocity, acceleration, jerk, path length, economy of volume) and modified OSATS score. Short-term clinical stressors during a laparoscopic training task significantly worsened kinematic markers (velocity, acceleration, jerk, path length) and objective evaluation scores.