The Intermittent Pneumoperitoneum Scheme of Work Breaks in Complex Laparoscopic Surgery
Condition: Stress Physiology; Staff Work Load; Artificial Pneumoperitoneum; Anuria
MeSH terms: Pneumoperitoneum
Study type: Interventional

Summary: 
      Many people spanning from air traffic controllers to simple production line workers share
      regular compulsive breaks to revert fatigue whilst they work. This is uncommon for medical
      operators - a macho image is still as prevalent in real life as it is in countless TV series.

      We report on the first clinical trial on regular intraoperative breaks. For one time we
      turned our scientific curiosity to ourselves. This included the intraoperative collection of
      body fluids and required transparency which was not easy to obtain. It was rewarded with
      striking results: Regular intraoperative breaks lowered significantly the operators stress
      hormone levels, improved error-performance testing results and musculoskeletal fatigue
      scores. Subjectively the breaks enhanced the practitioners satisfaction.

      Surprisingly the operator's breaks were not at the cost of the patient: because the did not
      prolong the overall operation time at all and - in our setting- they significantly increased
      of cardiac output and urine production.
    

Detailed description: 
      Abstract

      Background: Work breaks at close intervals are common in fields with high workload but not
      yet for medical operators. We evaluated the effects of intraoperative breaks (five minutes
      every half hour) on the surgeon and on the patient.

      Methods: Operations were randomized to either a scheme with intraoperative breaks and release
      of the pneumoperitoneum (intermittent pneumoperitoneum = IPP) or a conventional conduct
      (CPP). Stress hormones and α-amylase were determined in the surgeon's saliva pre-, intra- and
      postoperatively. Mental performance and error scores, musculoskeletal strain and continuous
      ECG were secondary endpoints. The children's physiology was monitored.

      Findings:

      Regular intraoperative breaks did not prolong the operation. The surgeon's cortisol levels
      during the operation were reduced. There were fewer intraoperative events in the IPP vs. the
      CPP group. The pre- to postoperative increase in the error rates of the bp-concentration test
      was reduced in the IPP group. The relevant locomotive strain-scores were reduced by IPP.

      There was no negative impact on the patient. Interpretation: Our data support the idea that
      work breaks during complex laparoscopic surgery can reduce psychological stress and preserve
      performance with at least similar patient outcome compared to the traditional work scheme.
    

Intervention name(s): IPP
Intervention type(s): Behavioral
Intervention description(s): Institution of intraoperative breaks for the surgeon with release of pneumoperitoneum for patient
Other intervention name(s): break schemes
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: surgeon's physiology; stress response; break scheme