Society for Surgery of the Alimentary Tract

2005 Abstracts: Extended Operative Day Affects Performance on Laparoscopic Simulator

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Extended Operative Day Affects Performance on Laparoscopic Simulator
Joseph A. Talarico, Azam Jan, Vijay K. Maker, Marek Rudnicki, Advocate Illinois Masonic Hospital, Chicago, IL

INTRODUCTION: Fatigue is the inability to continue effective performance caused by excessive workload, stress, sleep loss, and circadian disruptions. Though much has been written in the literature about long resident work hours, very little research has investigated the effect of an extended operative day on surgical resident's performance. Laparoscopic surgery is particularly demanding, requiring a large amount of attention and focus to create a three-dimensional operative plan given only a two-dimensional image. The Minimally Invasive Surgical Trainer (MIST-VR) is a valid model for assessing laparoscopic performance.

PURPOSE: The purpose of this prospective study was to identify the effect of an extended operative day resident's performance using MIST-VR. METHODS: Ten surgical residents were introduced to MIST VR and became skilled on an easy setting to minimize the effect of learning. Subsequently, they completed two separate sessions of six MIST VR tasks on hard setting before and after at least six hours of operating. Fatigue was measured with a measured modified Iowa Fatigue Scale. Test results were averaged and analyzed using paired student t-test. RESULTS: Residents average fatigue score increased from 32.5�6.36 to 40.2�4.29 after more than six hours operating. There were significant differences in errors (p<.04), time (p<.03), and total score (p<.02) for Manipulation Diathermy, and errors (p<.0002) and total score (p<.01) for Traversal between the rested (preoperative) and fatigued (postoperative) residents. The remaining four tasks saw no significant differences. Table below reflects summary of mean total scores on MIST-VR and mean Iowa score (*p<.05 PostOperative vs. PreOperative).

Task	PreOperative Score	PostOperative Score
Acquire Place	71.2� 40.9	72.0�39.5
Transfer Place	91.7�42.1	91.9�32.7
Traversal	206.4�106.7	304.8�131.2*
Withdraw/Insert	70.1�30.8	69.1�20.9
Diathermy	89.5�28.5	97.1�30.2
Manipulation Diathermy	274.0�99.2	311.5�73.7*
Fatigue score	32.5�6.4	40.2�4.3*

CONCLUSION: There is a significant change in the Iowa Score after at least six hours in the operating room indicating a long operative day leads to fatigue. There were increases in total score, technical errors, and time to accomplish two of six tasks in the tested residents. These tasks, Traversal and Manipulation Diathermy, are generally considered more complex than the other tasks. Resident performance on laparoscopic simulator changes with an extended operative day.

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