Abstract
A localized, intermittent muscle-cooling protocol was implemented to determine cooling garment efficacy in reducing upper extremity muscular fatigue and tremor in novice ( n = 10) and experienced surgeons ( n = 9). Subjects wore a muscle-cooling garment while performing multiple trials of a forearm exercise and paired suturing task to induce muscular fatigue and exercise-induced tremor. A reduction in tremor amplitude and an extension in time to fatigue were expected with muscle cooling as compared with control trials. Each subject completed an intervention session (5°C cooling condition) and a control session (32°C or thermal neutral condition). A paired samples t test indicated that tremor amplitude was significantly reduced ( t [8] = 1.89458; p < 0.05) in experienced surgeons in two dimensions (up and down, and back and forth). Tremor amplitude was reduced in novice surgeons but the effect was not significant. Time to fatigue and suture time improved in both cohorts with muscle cooling, but the effect did not reach significance. Results from the pilot work suggest muscle cooling as an intervention for reduction of fatigue and tremor is very promising, warranting further investigation. Surgical specialties that require prolonged procedures might benefit more from this intervention.
Highlights
Surgical fatigue syndrome (SFS) describes the normal decline observed in surgical performance after 4 hours of surgery.[10]
Other surgical editorials have repeatedly called for research on older surgeons, biometric evaluations of aging surgeons will remain limited until they make themselves more available as research subjects
Exercise-induced tremor, whether from one intense surgery or multiple surgeries, can cause muscle strain and result in various injuries, which may be prevented through the use of better ergonomic design and potential muscle cooling therapies
Summary
Surgical fatigue syndrome (SFS) describes the normal decline observed in surgical performance after 4 hours of surgery.[10] Characteristics of SFS include mental exhaustion, increased irritability, decreased surgical judgment, and decreased dexterity. Preventative measures for SFS include rest periods (at least 10 minutes for every 2 hours) and a shared workload. Overuse syndromes (tenosynovitis, repetitive strain injury, cumulative trauma disorder, acute carpal tunnel syndrome) frequently occur from repetitive minimally invasive surgeries. Increased effort prior to fatigue has been documented by electromyography of forearm muscles, indicating increased risk for injury that may occur prior to conscious awareness of muscle fatigue.[11] Anatomically, risk for injury develops from nerve compression at both the superficial terminal branch and the dorsal digital branches of the radial nerve and the palmar digital nerves when manipulating laparoscopic instruments. Superficial cooling would slow nerve-firing rates, the musclecooling protocol implemented in this research cools at a more proximal region than the nerve branches mentioned
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