Examining Surgeon Stress in Robotic and Laparoscopic Surgery

Background: Robotic surgery may decrease surgeon stress compared to laparoscopic. To evaluate intraoperative surgeon stress, we measured salivary alpha-amylase and cortisol. We hypothesized robotic elicited lower increases in surgeon salivary amylase and cortisol than laparoscopic. Study Design: Surgical faculty (n=7) performing laparoscopic and robotic operations participated. Demographics: age, years in practice, time using laparoscopic vs robotic, comfort level and enthusiasm for each. Operative data included operative time, WRVU (surgical “effort”), resident year. Saliva was collected using passive drool collection system at beginning, middle and end of each case; amylase and cortisol measured using ELISA. Standard values were created using seven-minute exercise (HIIT), collecting saliva pre- and post-workout. Linear regression and Student’s t test used for statistical analysis; p-values < 0.05 were significant. Results: Ninety-four cases (56 robotic, 38 laparoscopic) were collected (April-October 2022). Standardized change in amylase was 8.4±4.5 (p<0.001). Among operations, raw maximum amylase change in laparoscopic and robotic was 23.4±11.5 and 22.2±13.4; raw maximum cortisol change was 44.21±46.57 and 53.21±50.36 respectively. Values normalized to individual surgeon HIIT response, WRVU, and operative time, showing 40% decrease in amylase in robotic: 0.095±0.12, vs laparoscopic: 0.164±0.16 (p<0.02). Normalized change in cortisol was: laparoscopic 0.30±0.44, robotic 0.22±0.4 (p=NS). On linear regression (p<0.001), surgeons comfortable with complex laparoscopic cases had lower change in normalized amylase (p<0.01); comfort with complex robotic was not significant. Conclusion: Robotic may be less physiologically stressful, eliciting less increase in salivary amylase than laparoscopic. Comfort with complex laparoscopic decreased stress in robotic, suggesting laparoscopic experience is valuable prior to robotic.