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A prospective randomized trial on heart rate variability of the surgical team during laparoscopic and conventional
1Department of General, Visceral, Vascular and Thoracic Surgery, Charité, Campus Mitte, Humboldt University, Schumannstr, 20-21, D-10117 Berlin, Germany. bboehm@charite.de
Hypothesis:
Mental strain measured by heart rate variability differs during laparoscopic and conventional sigmoid resections.
Design:
Prospective randomized study.
Setting:
University hospital.
Participants:
Two surgeons performed 10 conventional and 10 laparoscopic sigmoid resections, alternating roles as primary surgeon and assistant. The kind of technique was randomly chosen each time.
Intervention:
Electrocardiograms of the surgeon and assistant were continuously recorded during the procedures and heart rate variability was analyzed off-line. The first 10 procedures (5 laparoscopic and 5 conventional) were performed by the more experienced and the next 10 by the less experienced surgeon.
Main Outcome Measures:
Heart rate variability was determined by power spectral analysis as heart rate in beats per minute, high frequency (HF) and low frequency (LF) components in normalized units, and LF/HF ratio.
Results:
Results are given for heart rate, HF, LF, and LF/HF ratio for the following variables: laparoscopic surgery: 87.9, 14.7, 90.1, 7.5; conventional surgery: 90.2, 17.1, 87.6, 6.4; surgeon: 94.0, 13.5, 91.4, 8.4; first assistant: 84.1, 17.8, 86.3, 5.6; more experienced surgeon: 93.1, 16.5, 87.8, 6.4; and less experienced surgeon: 85.0, 14.8, 90.0, 7.5. The LF/HF ratio was significantly higher (P<.05) for laparoscopic compared with conventional surgery and for the surgeon compared with the assistant (P<.001), but not between the less and the more experienced surgeons.
Conclusion:
Performing laparoscopic colorectal surgery causes higher mental strain in surgeons than performing conventional surgery.