title: Effects of intraoperative breaks on mental and somatic operator fatigue: a randomized clinical trial.
abstract: BACKGROUND
  Intermittent work breaks are common in fields with high workload but not yet for surgeons during operations. We evaluated the effects of intraoperative breaks during complex laparoscopic surgery (5 min every half hour) on the surgeon.
  
  
  METHODS
  Fifty-one operations were randomized to a scheme with intraoperative breaks and release of the pneumoperitoneum (intermittent pneumoperitoneum (IPP)) or conventional conduct (CPP). Stress hormones and α-amylase were determined in the surgeon's saliva pre-, intra-, and postoperatively. Mental performance and error scores, musculoskeletal strain, and continuous ECG were secondary endpoints.
  
  
  RESULTS
  Regular intraoperative breaks did not prolong the operation (IPP vs. CPP group: 176 vs. 180 min, p > 0.05). The surgeon's cortisol levels during the operation were reduced by 22 ± 10.3% in the IPP vs. the CPP group (p < 0.05). There were significantly fewer (p < 0.05) intraoperative events in the IPP vs. the CPP group, which yielded higher α-amylase peaks. The pre- to postoperative increase in the error rates of the bp-concentration test was fourfold reduced in the IPP group (p = 0.052). The relevant locomotive strain-scores were grossly reduced by IPP (p < 0.001).
  
  
  CONCLUSIONS
  Our data support the idea that work breaks during complex laparoscopic surgery can reduce psychological stress and preserve performance without prolongation of the operation time compared with the traditional work scheme.
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany. ceng@bdc.de
authors.forename: Carsten
authors.initials: C
authors.lastname: Engelmann
authors.forename: Mischa
authors.initials: M
authors.lastname: Schneider
authors.forename: Clemens
authors.initials: C
authors.lastname: Kirschbaum
authors.forename: Gudela
authors.initials: G
authors.lastname: Grote
authors.forename: Jens
authors.initials: J
authors.lastname: Dingemann
authors.forename: Stefan
authors.initials: S
authors.lastname: Schoof
authors.forename: Benno M
authors.initials: BM
authors.lastname: Ure
mesh_terms: D000328:Adult; D001248:Asthenopia / Q000209:etiology / Q000517:prevention & control; D001288:Attention; D002648:Child; D002675:Child, Preschool; D003687:Dehydroepiandrosterone / Q000032:analysis; D004562:Electrocardiography; D005221:Fatigue / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology / Q000523:psychology; D007432:Intraoperative Period; D010535:Laparoscopy; D008297:Male; D005222:Mental Fatigue / Q000209:etiology / Q000517:prevention & control; D018763:Muscle Fatigue; D010820:Physicians / Q000523:psychology*; D011028:Pneumoperitoneum, Artificial; D011597:Psychomotor Performance; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control; D013739:Testosterone / Q000032:analysis; D000516:alpha-Amylases / Q000032:analysis
chemical_list: D013739:Testosterone; D003687:Dehydroepiandrosterone; D000516:alpha-Amylases; D006854:Hydrocortisone