Background:Robotic techniques reduce the invasiveness and improve outcomes compared to traditional surgery. Greater technical challenges of robotics suggest that this approach is more stressful for surgeons, particularly during the learning phase. The purpose of this study was to objectively quantify stress during robotic procedures in real-time.
Method:We used an innovative method based on a body worn sensor to measure stress based on heart rate monitoring. The measured stress was compared between three different cases, including robotic surgery on a cadaver (Case 1), actual cardiac robotic surgery (Case 2), and supervising a cardiac robotic surgery (Case 3). An algorithm was designed to estimate HRV based on the standard deviation of R-R intervals. Before starting the surgery, baseline stress was assessed using the same algorithm. Medium and high-stress periods were defined when HRV was in the range of 60-85% and below 60% of baseline HRV, respectively.
Results:Interestingly the level of stress was different between the three cases. The stress was the highest during the case 3, when the subject supervised a surgeon trainee (37% high stress v. 2.3% in case 2 and 0% in the case 3). The medium stress period was higher comparable between cases (30%, 29% and 36%, respectively for the cases 1, 2, and 3).
Conclusion:This pilot study suggests potential benefits of measuring stress during cardiac surgery using body worn sensor. Interestingly, results suggest that the highest level of stress might occur when supervising a robotic surgery rather than performing surgery. Assuming these findings are confirmed, HRV may provide a metric that could be used to improve operation room stress.