title: Relax, it's just laparoscopy! A prospective randomized trial on heart rate variability of the surgeon in robot-assisted versus conventional laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic surgery might be beneficial for the patient, but it imposes increased physical and mental strain on the surgeon. Robot-assisted laparoscopic surgery addresses some of the laparoscopic drawbacks and may potentially reduce mental strain. This could reduce the risk of surgeon's fatigue, mishaps and strain-induced illnesses, which may eventually improve the safety of laparoscopic surgical procedures.
  
  
  METHODS
  To test this hypothesis, a randomized study was performed, comparing both heart rate and heart rate variability (HRV) of the surgeon as a measure of total and mental strain, respectively, during conventional and robot-assisted laparoscopic cholecystectomy.
  
  
  RESULTS
  Both heart rate and HRV (the low-frequency band/high-frequency band ratio) were significantly decreased when using robotic assistance.
  
  
  CONCLUSIONS
  These data suggest the use of the daVinci® Surgical System leads to less physical and mental strain of the surgeon during surgery. However, assessing mental strain by means of HRV is cumbersome since there is no clear cutoff point or scale for maximum tolerated strain levels and its related effects on surgeon's health.
authors.affiliation: Department of General Surgery, Laurentius Hospital Roermond, Roermond, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Heemskerk
authors.forename: H Reinier
authors.initials: HR
authors.lastname: Zandbergen
authors.forename: Sander W M
authors.initials: SW
authors.lastname: Keet
authors.forename: Ingrid
authors.initials: I
authors.lastname: Martijnse
authors.forename: Gust
authors.initials: G
authors.lastname: van Montfort
authors.forename: Rob J A
authors.initials: RJ
authors.lastname: Peters
authors.forename: Vesna
authors.initials: V
authors.lastname: Svircevic
authors.forename: R Arthur
authors.initials: RA
authors.lastname: Bouwman
authors.forename: Cor G M I
authors.initials: CG
authors.lastname: Baeten
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Bouvy
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000523:psychology; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009784:Occupational Diseases / Q000175:diagnosis; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods* / Q000523:psychology; D018709:Statistics, Nonparametric; D013315:Stress, Psychological; D066231:Surgeons / Q000523:psychology*