Three different types of surgeon-specific stress reactions identified by laparoscopic simulation in a virtual scenario

Surg Endosc. 2008 May;22(5):1263-7. doi: 10.1007/s00464-007-9605-1. Epub 2007 Oct 18.


Background: Minimally invasive surgery causes higher mental strain for surgeons than conventional surgery and is significantly more stressful in consecutive cases. This study aimed to investigate whether individual stress responses are associated with intraoperative alterations of manual surgical skills and technical errors of the laparoscopic surgeon.

Methods: The LapSim virtual reality simulator was used. Stress measurement was carried out for 18 surgeons performing a virtual cholecystectomy using the LapSim simulator in the context of the patient simulator provided by the METI Corporation. In the course of the study, the surgeons were exposed to different external stressors (S1-S4) in defined intervals. The activity of the sympathetic nervous system was evaluated by skin resistance with the help of a sympathicograph.

Results: Three different surgeon-specific stress reactions (SSR) could be identified. The first, SSR-1, with significant stress reactions during the study without recovery, showed larger laparoscopic extensions of movement but fewer intraoperative complications than SSR-2 (recovery after the stress reactions) or SSR-3 (without significant stress reactions).

Conclusions: The mental load of the laparoscopic surgeon might be highly optimized by continuous activity of the sympathetic nervous system. The question of what extent or quality of stress produces adverse effects remains unclear.

MeSH terms

  • Adult
  • Cholecystectomy, Laparoscopic / psychology*
  • Clinical Competence
  • Computer Simulation*
  • Female
  • Humans
  • Male
  • Medical Errors / psychology
  • Middle Aged
  • Models, Anatomic*
  • Monitoring, Physiologic
  • Stress, Psychological / diagnosis*
  • Stress, Psychological / physiopathology
  • Sympathetic Nervous System / physiology
  • User-Computer Interface*