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Work breaks during minimally invasive surgery in children: patient benefits and surgeon's perceptions
Carsten Engelmann1, Mischa Schneider, Gudela Grote
1Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany. engelmann.carsten@mh-hannover.de
Insights
Implementing intermittent pneumoperitoneum (IPP) breaks during pediatric laparoscopy benefits infant patients and improves surgeon communication. This strategy requires personalized adjustments for surgeon acceptance and optimal outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Patient Safety
Background:
- Previous research indicated intermittent pneumoperitoneum (IPP) with 5-minute breaks every 25 minutes reduces surgeon stress during pediatric laparoscopy.
- However, data on patient outcomes and surgeon perception of this break scheme were lacking.
Purpose of the Study:
- To evaluate the impact of an IPP break scheme on patient biometry and surgeon perception during pediatric laparoscopy.
- To compare outcomes between IPP and continuous pneumoperitoneum (CPP) in a randomized trial.
Main Methods:
- A randomized trial comparing IPP (n=26) with CPP (n=26) in pediatric laparoscopy patients.
- Comprehensive biometry data collection and analysis of patient hemodynamics, blood gas readings, and temperature.
- Surgeon perception and acceptance of the IPP break scheme assessed using behaviorally anchored rating scales.
Main Results:
- No significant differences in patient hemodynamics, blood gas levels, or temperature between IPP and CPP groups.
- Infants under 1 year showed significantly higher urine volumes with IPP.
- IPP demonstrated a significantly higher area under the curve for cardiac output during long operations.
- Surgeons reported improved team communication and coherence with the IPP scheme.
- Surgeon acceptance varied based on individual work style and self-perception, with an overall approval rating.
Conclusions:
- The intermittent pneumoperitoneum break scheme is safe for pediatric patients and beneficial for infants.
- The scheme enhances surgeon team communication and can improve objective surgical performance metrics.
- Tailoring break duration and implementation to individual surgeon preferences is crucial for maximizing acceptance and effectiveness.
Introduction:
We recently reported that 5-minute work breaks every 25 minutes during long lasting laparoscopy in children (intermittent pneumoperitoneum [IPP] scheme) decrease the surgeon's stress markers such as saliva cortisol and heart rate and improve time-concentration scores significantly. Data on the impact of breaks on the patient and on the surgeon's perception of breaks, however, are still lacking.
Materials And Methods:
We present the comprehensive biometry data of a randomized trial including 26 patients operated with (IPP) and 26 patients without breaks (continuous pneumoperitoneum [CPP]). Moreover, we analyzed the surgeon's perception of the break scheme using behaviorally anchored 10-point rating scales.
Results:
There were no significant intergroup differences in the pooled patients' hemodynamics including cardiac output, blood gas readings, and temperature during and after the operation. Infants <1 year of age undergoing IPP versus CPP produced significantly higher urine volumes (1.60 ± 1.8 vs. 0.67 ± 1.00 mL/h/m2, p < 0.05). The overall area under the curve (AUC) of their cardiac output was 106.7 ± 41.1 (IPP) versus 78.0 ± 41.3 (CPP). This difference became significant during long operations (p < 0.05 for AUC 150 to 270 minutes). Surgeon's break perception and acceptance: team communication shifted from an implicit "mute communication" to an explicit way "issues are outspoken" by +4.7 ± 2.6 (p < 0.05) with improved coherence between operator and assistants (+3.9 ± 2.1). However, when questioned whether there was one particular welcome (5.1 ± 1) or extremely disturbing (6.4 ± 2.4) break during the entire procedure, the latter yielded a higher score (p > 0.05). Acceptance varied according to the surgeon's own esteem of his/her work style. Operators with high self-ratings for "fast" were inclined to put up with shorter breaks ("fast" vs. "slow" = 3.5 ± 1.4 vs. 5.5 ± 0.7, p < 0.05). Overall the scheme was approved (5.9 ± 3.2).
Conclusions:
A break scheme has no detrimental effect on patient physiology and is beneficial in infants. It needs careful tailoring to both the surgeon's work situation and self-esteem to gain acceptance.
