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Single-incision cholecystectomy more stressful, physically demanding to surgeon
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Compared with 4-port laparoscopic cholecystectomy, single-incision laparoscopic cholecystectomy may be more stressful and physically demanding to surgeons, which could affect patient outcomes, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2015 Annual Meeting.
Juliane Bingener-Casey, MD, from Mayo Clinic in Rochester, Minnesota, and colleagues performed a double blind, randomized controlled trial to compare patient outcomes for single-incision (n = 23) vs. 4-port (n = 25) cholecystectomy, during which they monitored heart rate and salivary cortisol levels to measure surgeon stress and workload.
Juliane Bingener-Casey
Using a portable heart rate monitor, data were sampled before surgery, after clipping the cystic duct and immediately after surgery. Average and maximum heart rate, as well as the mean change between the points of measurement, were analyzed. Salivary cortisol levels were sampled at the same points of measurement and were analyzed using enzyme-linked immunosorbent assay (ELISA; Salimetrics Inc.). Surgeons also completed a validated workload assessment questionnaire (SURG-TLX) after each procedure.
Single-incision surgery was associated with higher maximum heart rates after surgery (P < .01), higher mean change in maximum heart rate during and before surgery (P < .05), as well as after and before surgery (P < .01), higher mean change in average heart rate during and before surgery (P < .01), and higher salivary cortisol levels during surgery (P < .01). Higher physical demands also were reported on the questionnaire (P < .05).
The investigators concluded that single-incision laparoscopic cholecystectomy was associated with higher objective stress measures and subjective physical workload measures, indicating that this procedure may be more stressful and physically demanding for surgeons compared with 4-port procedures. As this may affect outcomes, they wrote, “ergonomic improvement on [single-incision laparoscopic cholecystectomy] is necessary.” – by Adam Leitenberger
Reference:
Abdelrahman AM, et al. Abstract S007. Presented at: Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting; April 15-18, 2015; Nashville, Tennessee.
Disclosure: Bingener-Casey reports this trial was supported by an NIDDK grant, that the researchers also received funding for other work from Stryker and Nestle, and that she is a member of the advisory board for Titan Medical.