Effects of intraoperative breaks on mental and somatic operator fatigue: a randomized clinical trial.
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.
Engelmann
Carsten
C
Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany. ceng@bdc.de
Schneider
Mischa
M
Kirschbaum
Clemens
C
Grote
Gudela
G
Dingemann
Jens
J
Schoof
Stefan
S
Ure
Benno M
BM
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
D013739:Testosterone; D003687:Dehydroepiandrosterone; D000516:alpha-Amylases; D006854:Hydrocortisone