Impact of single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial
Impact of single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial
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DOI：
10.1007/s00464-015-4332-5
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发表时间：
2016-03-01
影响因子：
3.1
通讯作者：
Hallbeck, M. Susan
中科院分区：
文献类型：
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作者：
Abdelrahman, Amro M.;Bingener, Juliane;Hallbeck, M. Susan
介绍单切口腹腔镜胆囊切除术(SILC)可以提高患者的满意度，但是，SILC可能会增加外科医生的工作量。方法采用随机双盲对照试验，比较SILC和CLC(NCT0148943)的手术效果，通过手术负荷指数问卷(Surg-TLX)、最大心率、唾液皮质醇水平和器械可用性调查等4项指标评估外科医生的工作负荷。最大心率和唾液皮质醇水平从外科医生随机分配手术前、术中胆囊管夹闭后和缝合皮肤时采集。在每一次手术后，外科医生完成了Surg-TLX和器械可用性调查。对因变量进行t检验、Wilcoxon秩和检验和Kruskal-Wallis非参数方差分析(SILC与CLC)，α=0.05。结果23个SILC和25个CLC进入意向处理分析。SILC和CLC在患者人口统计学和手术持续时间方面没有显著差异。SILC组的外科医生术后最大心率显著高于CLC组(p<；0.05)。SILC术中和术后最大心率的平均变化也显著高于CLC(P<；0.05)。SILC患者唾液皮质醇水平显著高于CLC患者(p<；0.01)。SILC组器械操作笨拙和精细运动受限的发生率明显高于CLC组(p<；0.01)。在外科医生报告的Surg-TLX中，身体需求子量表对SILC的要求显著高于CLC(p<；0.05)。结论外科医生的心率、唾液皮质醇水平、器械可用性和Surg-TLX评分表明SILC的压力和对身体的要求显著高于CLC。外科医生的压力和工作量可能会影响患者的预后；因此，有必要对SILC进行人机工程学改进。
Introduction Single-incision laparoscopic cholecystectomy (SILC) may lead to higher patient satisfaction; however, SILC may expose the surgeon to increased workload. The goal of this study was to compare surgeon stress and workload between SILC and conventional laparoscopic cholecystectomy (CLC).Methods During a double-blind randomized controlled trial comparing patient outcomes for SILC versus CLC (NCT0148943), surgeon workload was assessed by four measures: surgery task load index questionnaire (Surg-TLX), maximum heart rate, salivary cortisol level, and instruments usability survey. The maximum heart rate and salivary cortisol levels were sampled from the surgeon before the random assignment of the surgical procedure, intraoperatively after the cystic duct was clipped, and at skin closure. After each procedure, the surgeon completed the Surg-TLX and an instrument usability survey. Student's t tests, Wilcoxon rank sum test, and Kruskal-Wallis non-parametric ANOVAs on the dependent variables by the technique (SILC vs. CLC) were performed with alpha = 0.05.Results Twenty-three SILC and 25 CLC procedures were included in the intent-to-treat analysis. No significant differences were observed between SILC and CLC for patient demographics and procedure duration. SILC had significantly higher post-surgery surgeon maximum heart rates than CLC (p < 0.05). SILC also had significantly higher mean change in the maximum heart rate between during and post-procedure (p < 0.05) than CLC. Salivary cortisol level was significantly higher during SILC than CLC (p < 0.01). Awkward manipulation of the instruments and limited fine motions were reported significantly more frequently with SILC than CLC (p < 0.01). In the surgeon-reported Surg-TLX, subscale of physical demand was significantly more demanding for SILC than CLC (p < 0.05).Conclusions Surgeon heart rate, salivary cortisol level, instrument usability, and Surg-TLX ratings indicate that SILC is significantly more stressful and physically demanding than the CLC. Surgeon stress and workload may impact patients' outcomes; thus, ergonomic improvement on SILC is necessary.