The Impact of High Complexity Total Pelvic Exenteration on Surgeon Fatigue: The FaME Study

Total pelvic exenteration surgery (TPE) is a radical procedure requiring significant surgeon mental and physical endurance. Literature surrounding surgeon fatigue remains minimal. This study investigated impact of performing high complexity (bony, vascular and neurological resection) TPE on surgeon fatigue.

Two surgeons ([#1]/[#2]) delivering high complexity TPEs (1st November 2022-1st September 2023) in a tertiary centre (110/annum) were assessed using a predefined protocol. Surgeon heart rate, concentration performance (d2 Brickencamp test) and Surgery Task Load Index (SURG-TLX) were measured across intraoperative stages (mobilisation, dissection, reconstruction). Surgeons underwent baseline cardiopulmonary exercise testing.

Baseline VO₂ max and anaerobic thresholds: #1 = 37.6 mL/kg/min, 50%; #2 = 54.3 mL/kg/min, 70%. Mean error rate (ER): d2 test 1 (pre-procedure) and 2 (post-dissection): #1 = 3.58% [0.91%-8.60%] [SD = 3.16, 95% CI = 0.27 to 6.91], #2 = 4.46% [1.37%-7.23%] [SD = 2.55, 95% CI = 1.79 to 7.14]. Greater HR deviation correlated with higher test 2 ER for both subjects (p > 0.05). During dissection, HR increased from baseline: mean of 70% [#1] and 51.9% [#2]; max HR 106.7% [#1] and 111.5% [#2]. Subjects demonstrated smaller mean HR increase from baseline during two consultant dissection versus with trainees (#1 = 46.7% [p < 0.001]; #2 = 48.1% [p > 0.05]). Greater mean dissection time did not significantly affect mean test 2 ER (p > 0.05, 95% CI -2.88 to 4.90). SURG-TLX situational stress domain was most impacted.

Surgeon HR fluctuations corresponded with significant intraoperative events. Assistant dependent HR fluctuation and increased average d2 ER was demonstrated by greater HR deviations during dissection. Further investigation optimising strategies minimising surgeon fatigue is required.