title: Impact of single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial.
abstract: BACKGROUND
  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.
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. abdelrahman.amro@mayo.edu.|Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. abdelrahman.amro@mayo.edu.
authors.forename: Amro M
authors.initials: AM
authors.lastname: Abdelrahman
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Juliane
authors.initials: J
authors.lastname: Bingener
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.|Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Denny
authors.initials: D
authors.lastname: Yu
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.|Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Bethany R
authors.initials: BR
authors.lastname: Lowndes
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.|Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Amani
authors.initials: A
authors.lastname: Mohamed
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: McConico
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. Hallbeck.Susan@mayo.edu.|Department of Surgery, Mayo Clinic, Rochester, MN, USA. Hallbeck.Susan@mayo.edu.|Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Hallbeck.Susan@mayo.edu.
authors.forename: M Susan
authors.initials: MS
authors.lastname: Hallbeck
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry; D013312:Stress, Physiological; D066231:Surgeons; D011795:Surveys and Questionnaires; D016526:Workload
chemical_list: D006854:Hydrocortisone
keywords: Laparoscopy; SILC; Stress; Surg-TLX; Surgeon; Workload