SOS save our surgeons: Stress levels reduced by robotic surgery

Robotic-assisted laparoscopic surgery (RALS) is making an increasingly significant contribution to the field of gynaecological surgery. RALS offers similar patient benefits to standard laparoscopic surgery (SLS) with a potentially more ergonomically friendly and less stressful environment for the surgeon. However, our understanding of how RALS may potentially reduce physiological stress on the surgeon is currently limited. To assess how performing surgical tasks using RALS in comparison to SLS impacts on hypothalamic pituitary adrenal (HPA) axis function and sympathetic nervous system (SNS) activity, two key indicators of the physiological stress response. This study is an analytical, within subjects, crossover design study. Sixteen surgically inexperienced medical students performed tasks with both SLS and RALS instrumentation. Blood pressure (BP) was taken before and after task performance. Skin conductance level (SCL), heart rate (HR) and HR variability (HRV) were measured continuously during task performance. Pre-and post-task saliva samples were collected to determine cortisol levels using ELISA. SCL was significantly lower during RALS in comparison to SLS task performance (p< 0.05). HR was significantly lower during RALS vs. SLS tasks (p< 0.01). Both HRV measures were significantly higher during RALS vs. SLS tasks (p< 0.01). Cortisol levels and BP were lower during RALS vs. SLS but did not reach statistical significance (p= 0.73 and p= 0.22, respectively). Stress can impair surgeon's technical and nontechnical skills. These results indicate that the improved ergonomic setup of RALS has a beneficial impact on physiological indicators of stress. This also demonstrates the potential of RALS to reduce the negative effects of long-termstress exposure on the surgeon.