Utilization of wearable technology to assess physiological stress during laparoscopic surgery training

Stress negatively impacts laparoscopic performance in surgical residents. This study evaluated the relationship between physiological stress and performance using wearable technology.

General surgery residents participated in a 2-day laparoscopic training course using live porcine models. Mean heart rate along with heart rate variability (HRV) parameters including standard deviation of R-R intervals (SDNN) and root-mean-square of successive differences of R-R intervals (RMSSD), were measured using a chest-worn ECG sensor. Operative performance was assessed using the Global Operative Assessment of Laparoscopic Skills (GOALS) and the Objective Performance Rating Scale (OPRS). Parameters were measured at rest, baseline, and intraoperatively. Comparison between day-1 and day-2 were performed within groups. Correlations between changes in parameters and operative performance across time were analyzed.

Junior (PGY1-2, n=5) and senior (PGY3-5, n=5) residents formed teams, alternating as primary surgeon and assistant. Juniors led basic procedures (cholecystectomy, incisional hernia repair) having seniors assisting. Seniors handled advanced ones (Nissen fundoplication, splenectomy, colon-resection) having juniors assisting. Regardless of role, stress levels were elevated in all participants during each procedure compared to rest, peaking highest during splenectomies and colon resections. Analyses across time revealed that higher mean heart rate correlated with lower performance (r=-0.41, p=0.07), while higher SDNN and RMSSD correlated with higher performance (r=0.56, p=0.008; r=0.63, p<0.001, respectively).

Reducing physiological stress can enhance laparoscopic performance. Wearable technology shows promise for improving surgical training.