title: Mental distress and effort to engage an image-guided navigation system in the surgical training of endoscopic sinus surgery: a prospective, randomised clinical trial.
abstract: The use of image-guided navigation systems in the training of FESS is discussed controversy. Many experienced sinus surgeons report a better spatial orientation and an improved situational awareness intraoperatively. But many fear that the navigation system could be a disadvantage in the surgical training because of a higher mental demand and a possible loss of surgical skills. This clinical field study investigates mental and physical demands during transnasal surgery with and without the aid of a navigation system at an early stage in FESS training. Thirty-two endonasal sinus surgeries done by eight different trainee surgeons were included. After randomization, one side of each patient was operated by use of a navigation system, the other side without. During the whole surgery, the surgeons were connected to a biofeedback device measuring the heart rate, the heart rate variability, the respiratory frequency and the masticator EMG. Stress situations could be identified by an increase of the heart rate frequency and a decrease of the heart rate variability. The mental workload during a FESS procedure is high compared to the baseline before and after surgery. The mental workload level when using the navigation did not significantly differ from the side without using the navigation. Residents with more than 30 FESS procedures already done, showed a slightly decreased mental workload when using the navigation. An additional workload shift toward the navigation system could not be observed in any surgeon. Remarkable other stressors could be identified during this study: the behavior of the supervisor or the use of the 45° endoscope, other colleagues or students entering the theatre, poor vision due to bleeding and the preoperative waiting when measuring the baseline. The mental load of young surgeons in FESS surgery is tremendous. The application of a navigation system did not cause a higher mental workload or distress. The device showed a positive effort to engage for the trainees with more than 30 FESS procedures done. In this subgroup it even leads to decreased mental workload.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Ulm, University Clinic of Ulm, Ulm, Germany. marie-nicole.theodoraki@uniklinik-ulm.de.
authors.forename: M N
authors.initials: MN
authors.lastname: Theodoraki
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany.
authors.forename: G J
authors.initials: GJ
authors.lastname: Ledderose
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Becker
authors.affiliation: Clinics and Private Practice Dr. Gärtner, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Leunig
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Arpe
authors.affiliation: Industrial, Engineering and Organisational Psychology of the Technical University, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Luz
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Stelter
mesh_terms: D000328:Adult; D001296:Audiovisual Aids; D002983:Clinical Competence / Q000592:standards; D018961:Educational Technology / Q000379:methods*; D005260:Female; D013502:General Surgery / Q000193:education / Q000379:methods / Q000592:standards; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000193:education / Q000523:psychology; D010254:Paranasal Sinus Diseases / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery*; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013647:Task Performance and Analysis; D016526:Workload