TY - JOUR
T1 - Impact of single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload
T2 - a randomized controlled trial
AU - Abdelrahman, Amro M.
AU - Bingener, Juliane
AU - Yu, Denny
AU - Lowndes, Bethany R.
AU - Mohamed, Amani
AU - McConico, Andrea L.
AU - Hallbeck, M. Susan
N1 - Funding Information:
This study was funded partially by US Department of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases Grant (NIDDK Grant) (K23 DK 93553), Mayo Clinicâs Department of Surgery Research, and the Robert D. and Patricia E Kern Center for the Science of Health Care Delivery. The authors would like to thank Dr. Charles Bruce and Preventice®for the BodyGuardian®heart rate monitoring equipment and analysis. We would also like to thank all the surgeons who participated in this study and the Center for Clinical and Translational Science for its support through the REDCap survey (CTSA Grant UL1 TR000135). Dr. Hallbeck has research funding from Stryker Endoscopy. Dr. Bingener is supported through a research grant (NIDDK), specified research through Nestle and Stryker Endoscopy, has received travel support from Intuitive Surgical, and serves on the Surgeon Advisory Board for Titan Medical. Dr. Yu has research funding from Stryker Endoscopy. Bethany Lowndes is supported through research grants from AHRQ and Stryker Endoscopy. Andrea McConico, Drs. Abdelrahman, and Mohamed have no conflicts of interest or financial ties to disclose
Funding Information:
This study was funded partially by US Department of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases Grant (NIDDK Grant) (K23 DK 93553), Mayo Clinic???s Department of Surgery Research, and the Robert D. and Patricia E Kern Center for the Science of Health Care Delivery. The authors would like to thank Dr. Charles Bruce and Preventice??for the BodyGuardian??heart rate monitoring equipment and analysis. We would also like to thank all the surgeons who participated in this study and the Center for Clinical and Translational Science for its support through the REDCap survey (CTSA Grant UL1 TR000135). Dr. Hallbeck has research funding from Stryker Endoscopy. Dr. Bingener is supported through a research grant (NIDDK), specified research through Nestle and Stryker Endoscopy, has received travel support from Intuitive Surgical, and serves on the Surgeon Advisory Board for Titan Medical. Dr. Yu has research funding from Stryker Endoscopy. Bethany Lowndes is supported through research grants from AHRQ and Stryker Endoscopy. Andrea McConico, Drs. Abdelrahman, and Mohamed have no conflicts of interest or financial ties to disclose
Publisher Copyright:
© 2015, The Author(s).
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Introduction: Single-incision laparoscopic cholecystectomy (SILC) may lead to higher patient satisfaction; however, SILC may expose the surgeon to increased workload. The goal of this study was to compare surgeon stress and workload between SILC and conventional laparoscopic cholecystectomy (CLC). Methods: During a double-blind randomized controlled trial comparing patient outcomes for SILC versus CLC (NCT0148943), surgeon workload was assessed by four measures: surgery task load index questionnaire (Surg-TLX), maximum heart rate, salivary cortisol level, and instruments usability survey. The maximum heart rate and salivary cortisol levels were sampled from the surgeon before the random assignment of the surgical procedure, intraoperatively after the cystic duct was clipped, and at skin closure. After each procedure, the surgeon completed the Surg-TLX and an instrument usability survey. Student’s t tests, Wilcoxon rank sum test, and Kruskal–Wallis nonparametric ANOVAs on the dependent variables by the technique (SILC vs. CLC) were performed with α = 0.05. Results: Twenty-three SILC and 25 CLC procedures were included in the intent-to-treat analysis. No significant differences were observed between SILC and CLC for patient demographics and procedure duration. SILC had significantly higher post-surgery surgeon maximum heart rates than CLC (p < 0.05). SILC also had significantly higher mean change in the maximum heart rate between during and post-procedure (p < 0.05) than CLC. Salivary cortisol level was significantly higher during SILC than CLC (p < 0.01). Awkward manipulation of the instruments and limited fine motions were reported significantly more frequently with SILC than CLC (p < 0.01). In the surgeon-reported Surg-TLX, subscale of physical demand was significantly more demanding for SILC than CLC (p < 0.05). Conclusions: Surgeon heart rate, salivary cortisol level, instrument usability, and Surg-TLX ratings indicate that SILC is significantly more stressful and physically demanding than the CLC. Surgeon stress and workload may impact patients’ outcomes; thus, ergonomic improvement on SILC is necessary.
AB - Introduction: Single-incision laparoscopic cholecystectomy (SILC) may lead to higher patient satisfaction; however, SILC may expose the surgeon to increased workload. The goal of this study was to compare surgeon stress and workload between SILC and conventional laparoscopic cholecystectomy (CLC). Methods: During a double-blind randomized controlled trial comparing patient outcomes for SILC versus CLC (NCT0148943), surgeon workload was assessed by four measures: surgery task load index questionnaire (Surg-TLX), maximum heart rate, salivary cortisol level, and instruments usability survey. The maximum heart rate and salivary cortisol levels were sampled from the surgeon before the random assignment of the surgical procedure, intraoperatively after the cystic duct was clipped, and at skin closure. After each procedure, the surgeon completed the Surg-TLX and an instrument usability survey. Student’s t tests, Wilcoxon rank sum test, and Kruskal–Wallis nonparametric ANOVAs on the dependent variables by the technique (SILC vs. CLC) were performed with α = 0.05. Results: Twenty-three SILC and 25 CLC procedures were included in the intent-to-treat analysis. No significant differences were observed between SILC and CLC for patient demographics and procedure duration. SILC had significantly higher post-surgery surgeon maximum heart rates than CLC (p < 0.05). SILC also had significantly higher mean change in the maximum heart rate between during and post-procedure (p < 0.05) than CLC. Salivary cortisol level was significantly higher during SILC than CLC (p < 0.01). Awkward manipulation of the instruments and limited fine motions were reported significantly more frequently with SILC than CLC (p < 0.01). In the surgeon-reported Surg-TLX, subscale of physical demand was significantly more demanding for SILC than CLC (p < 0.05). Conclusions: Surgeon heart rate, salivary cortisol level, instrument usability, and Surg-TLX ratings indicate that SILC is significantly more stressful and physically demanding than the CLC. Surgeon stress and workload may impact patients’ outcomes; thus, ergonomic improvement on SILC is necessary.
KW - Laparoscopy
KW - SILC
KW - Stress
KW - Surg-TLX
KW - Surgeon
KW - Workload
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U2 - 10.1007/s00464-015-4332-5
DO - 10.1007/s00464-015-4332-5
M3 - Article
C2 - 26194249
AN - SCOPUS:84959155543
SN - 0930-2794
VL - 30
SP - 1205
EP - 1211
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
IS - 3
ER -