Conference Paper

Assessing Stress During Robotic Cardiac Surgery – Comparison Between Simulated Surgery, Actual Surgery, And Surgery Supervision Cases

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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.

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... We implemented a single body worn sensor unobtrusively mounted on chest for recording heart rate data. Our team has recently developed and validated an algorithm to estimate spontaneous level of stress based on changes in HRV, i.e. variation in the time between consecutive R waves of an electrocardiogram (ECG) [33]. Several previous studies have monitored HRV as a measure of stress [34][35][36][37]. ...
Background Nearly all amputations in people with diabetes are preceded by a foot ulcer. It has been reported that stress is an important risk factor for slower wound healing and susceptibility to infection. The purpose of this study was to objectively monitor physiological stress response in patients with diabetic foot ulcer (DFU) during a clinical visit for wound dressing change. Methods Physiological stress was continuously monitored in 20 patients (Age: 56.7 ± 12.2 years) with DFU for duration of approximately 45 minutes including waiting, dressing change and post-dressing period. Stress was quantified using a custom algorithm based on standard deviation of R-R intervals; heart rate variability (HRV). To identify the change in level of stress, change in HRV was compared to baseline HRV. Medium and high-stress periods were defined when HRV was in the range of 60-85% and below 60% of baseline HRV, respectively. Results During the entire time of visit medium and high stress episodes happened for 28 ± 12.6% and 16 ± 18% of the time respectively. Further analyses of wound dressing time revealed that medium and high stress episodes were experienced for 47 ± 24% and 18.3 ± 27% of dressing time respectively. In addition, the duration of medium stress was significantly increased in average by 66% (difference = 21.8%, p = 0.002, 95%CI [7.5, 29.5]%) during dressing change compared to entire period of clinic visit. Conclusions This pilot study shows that patients with DFU experience moderate to high stress while visiting a wound clinic, which may negatively impact wound healing outcomes. In particular, the highest stressful condition was during wound dressing change, which may be related to painful dressing or perception of pain. Further investigation is required to explore association between quantified stress and outcomes of wound healing. In addition, future studies need to explore benefit of stress management in enhancing the outcomes of wound healing in patients with diabetes.
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