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Type: Journal article
Title: Effect of fatigue on laparoscopic skills: a comparative historical cohort study
Author: Daruwalla, J.
Marlow, N.
Field, J.
Altree, M.
Babidge, W.
Hewett, P.
Maddern, G.
Citation: ANZ Journal of Surgery, 2014; 84(3):137-142
Publisher: Wiley
Issue Date: 2014
ISSN: 1445-1433
Statement of
J. Daruwalla, N. Marlow, J. Field, M. Altree, W. Babidge, P. Hewett and G.J. Maddern
Abstract: Background: Fatigue has been shown to have a negative impact on surgical performance. However, there is a lack of research investigating its effect on laparoscopy, particularly in Australia. This study investigated whether fatigue associated with a surgeon’s usual workday led to a measurable drop off in laparoscopic surgical skills as assessed on a laparoscopic simulator. Methods: A comparative study involving two cohorts was undertaken: a study group whose data were collected prospectively was compared to a historical control group. Participants were required to reach a predetermined level of proficiency in each laparoscopic task on either a FLS or LapSim simulator. The participants in the study cohort were re-tested approximately 1 month after completing 10 h of work. The participants in the historical non-fatigued group were re-tested approximately 1 month after reaching proficiency. Comparisons between cohorts were made using a ‘decrease in score per day elapsed’ value to account for the natural attrition in skills over time and the variability in testing times within and between the two cohorts. Results: The decrease in overall score per day elapsed for fatigued participants was significantly greater than for historical non-fatigued participants, irrespective of the simulator type. Fatigue had a greater impact on certain laparoscopic skills, including peg transfer and knot tying. Participants who self-reported higher level of fatigue demonstrated significantly better skills than those who self-reported lower levels. Conclusion: Overall laparoscopic skill proficiency was reduced in the fatigued participants compared to the historical non-fatigued participants, with certain laparoscopic skills more affected than others.
Keywords: coping behaviour; fatigue; laparoscopy; surgeon
Rights: © 2013 The Authors ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons
DOI: 10.1111/ans.12069
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