Gynecologic Surgery Research Articles

Role of Laparoscopy in Reproductive Age Group Women with Gynecological Problems in a Tertiary Medical College

Background Laparoscopy has been a revolution in gynecological surgery as it is safe and minimally invasive. It can be used as a diagnostic as well as treatment modality for different gynecological problems like Chronic pelvic pain, adnexal cyst, ectopic pregnancy, Pelvic inflammatory disease and infertility.MethodsThis study was carried out at College of Medical Sciences-Teaching Hospital from April 2022 to March 2023 in 105 women. All the women undergoing laparoscopic surgeries were analyzed for indications, intraoperative findings and interventions.ResultsThe mean±SD of age of women was 30.34±7.73 years, most were in age group 26-35 years. The most common indications for Laparoscopy were for Adnexal cyst (74.28%), Chronic Pelvic Pain (14.28%) and Infertility (11.42%). The most common findings according to site were Ovarian pathology (48.60 %) followed by peritoneal pathology (22.9 %), Tubal pathology (17.14%) and normal findings (10.50%). In ovarian - Dermoid cyst (31.37 %), in tubal - ectopic pregnancy (55.56%), in peritoneal-Adhesions (45.83%) were the most common finding. In laparoscopic interventions, 26.70% had cystectomy, 14.3 % had salpingectomy and 13.3 % had Sterilization. Conclusions Laparoscopy as a modality for diagnosis and treatment of gynecological problems has been well established in recent times. It’s been a choice of surgery because of its reduce postoperative pain, shorter hospital stay, faster recovery and minimal scar. However, adequate advanced training and equipment are needed to perform skillful laparoscopic surgeries.

Quality of IVM ovarian tissue oocytes: impact of clinical, demographic, and laboratory factors.

To determine how clinical, demographic, and laboratory characteristics influence ovarian tissue oocyte quality. Immature cumulus-oocyte complexes were isolated from removed ovaries and cultured for 48-52h in either monophasic standard or biphasic CAPA media for fertility preservation. A total of 355 MII oocytes from 53 patients were described for intracytoplasmic and extracytoplasmic anomalies. Multiple clinical, laboratory, and demographic characteristics were analyzed. Statistically significant differences between independent groups in qualitative variables were identified using Pearson's χ2 and Fisher's exact tests. The diagnostic value of quantitative variables was assessed using the ROC curve analysis. Factors associated with the development of dysmorphism, taking patient age into account, were identified using the binary logistic regression analysis. Dysmorphisms were observed in 245 oocytes (69.0%), with a median number of dysmorphisms of 2. Oocyte dysmorphisms were found to be 2.211 times more likely to be detected in patients with ovarian cancer, while the presence of dark-colored cytoplasm was associated with gynecologic surgery in the anamnesis (p = 0.002; OR 16.652; 95% CI, 1.977-140.237; Cramer's V 0.187). Small polar bodies developed 2.717 times more often (95% CI, 1.195-6.18) in patients older than 35. In the case of ovarian transportation on ice at 4 ℃, the chances of development of cytoplasmic granularity increased 2.569 times (95% CI, 1.301-5.179). The use of biphasic CAPA IVM media contributed to a decrease in the probability of large polar body formation (p = 0.034) compared to the standard monophasic IVM media. Both patients' characteristics and laboratory parameters have an impact on the quality of IVM ovarian tissue oocytes.

Determination of Comfort Levels and Spiritual Care Needs of Gynecologic Cancer Patients with Abdominal Drains: A Cross-Sectional Descriptive Study in Turkey.

This study was conducted to determine the comfort levels and spiritual care needs of gynecologic cancer patients with abdominal drains. The study was conducted with 61 gynecologic cancer patients with abdominal drains at the gynecologic oncology surgery clinic of a state hospital in Turkey. Data were collected using the "Participant Information Form," "Perianesthesia Comfort Questionnaire (PCQ)", and "Spiritual Care Needs Inventory". Kolmogorov-Smirnov test and Mann-Whitney U test were used to analyze the data. It was found that the postoperative comfort of the patients in this study was above a moderate level. Patients who did not need spiritual care, did not fulfil religious rituals regularly and did not receive social support had a high level of comfort in the early postoperative period. Patients with gynecologic cancer were found to have high spiritual care needs. Patients without chronic diseases, possessing a single abdominal drain, familiar with the concept of spiritual care, expressing a need for spiritual care, engaging in regular religious rituals, and enjoying social support were identified as having elevated spiritual care needs. Within the framework of holistic nursing care provided to gynecologic cancer patients with abdominal drains, the results reveal the necessity of spiritual care and the importance of comfort.

Comparison of machine learning models for the prediction of hypertension in transgender patients undergoing gynecologic surgery.

Transgender patients face a higher burden of cardiovascular morbidity due to structural and biological stressors, particularly in low-resource settings. No studies exist comparing machine learning model development strategies for this unique patient cohort and limited literature exists comparing data/outcomes between transgender and cisgender populations. We compare machine learning models trained solely on transgender patients against models developed on a size-matched and ratio-matched cohort of cisgender patients and a 300-fold larger, ratio-matched cohort of cisgender patients undergoing obstetric/gynecologic procedures in the National Surgical Quality Improvement Program from January 1, 2005 through December 31, 2019. All models were developed to predict the outcome of hypertension. Statistical significance between models was calculated using 5-by-2 fold cross validation hypothesis testing. Among 626,102 patients having an obstetric/gynecologic surgery, there are 1959 transgender patients of which 85,405 (13.7%) have hypertension requiring medication. Saliently, the logistic regression machine learning models trained selectively on the transgender cohort have an AUC of 0.865 (95% CI: 0.83-0.90), with an accuracy of 85% (95% CI: 0.80-0.87) compared to (p < 0.05) the logistic regression model trained on the 300-fold larger combined cohort which has an AUC of 0.861 (95% CI: 0.82-0.90), with an accuracy of 83% (95% CI: 0.80-0.87). Machine learning models can be trained on smaller, selectively transgender populations and may perform similarly or better to predict cardiovascular outcomes in transgender patients, than models developed on predominantly cisgender patients; this can be useful in lower-resource settings with smaller-volume transgender patients.

Risk analysis of postoperative nausea and vomiting in patients after gynecologic laparoscopic surgery

AimsThis study is designed to identify risk factors of postoperative nausea and vomiting (PONV) in patients after gynecologic laparoscopic surgery and establish a nomogram model.MethodsIn this retrospective and multicenter study, we collected and analyzed data from 1233 patients who underwent gynecologic laparoscopic surgery. The Lasso algorithm was used to optimize the selection of independent variables in the development group. Multivariate logistic regression analysis was used to explore the risk factors of PONV to develop the predictive nomogram model. Finally, we used an internal and external verification group and machine learning (ML) to evaluate the accuracy and clinical applicability of the model.ResultsThe dosage of sufentanil in patient-controlled intravenous analgesia (PCIA), the dosage of remifentanil, the use of neostigmine, duration of surgery and the maximum value of the PETCO2 were risk factors of PONV in patients after gynecologic laparoscopic surgery. In contrast, the dosage of propofol during the surgery and the use of steroids were protective factors. The nomogram was then established to predict the incidence of PONV in these patients based on the above eight indicators. The C-index of the development group, internal, and external verification groups are 0.802, 0.857, and 0.966, respectively.ConclusionA nomogram model was developed to predict the incidence of PONV in patients after gynecologic laparoscopic surgery. This model was found to be reliable and of high clinical value.

Establishing a novel score system and using it to assess and compare the quality of ChatGPT-4 consultation with physician consultation for obstetrics and gynecology: A pilot study.

In the current study, we aimed to establish a quantified scoring system for evaluating consultation quality. Subsequently, using the score system to assess the quality of ChatGPT-4 consultations, we compared them with physician consultations when presented with the same clinical cases from obstetrics and gynecology. This study was conducted in the Women and Children's Hospital of Chongqing Medical University, a tertiary-care hospital with approximately 16 000-20 000 deliveries and 8500-12 000 gynecologic surgeries per year. The detailed data from obstetric and gynecologic medical records were analyzed by ChatGPT-4 and physicians; the consultation opinions were then generated respectively. All consultation opinions were graded by eight junior doctors using the novel score system; subsequently, the correlation, agreement, and comparison between the two types of consultation opinions were then evaluated. A total of 100 medical records from obstetrics and 100 medical records from gynecology were randomly selected. Pearson correlation analysis suggested a noncorrelation or weak correlation between consultations from ChatGPT-4 and physicians. Bland-Altman plot showed an unacceptable agreement between the two types of consultation opinions. Paired t tests showed that the scores of physician consultations were significantly higher than those generated by ChatGPT-4 in both obstetric and gynecologic patients. At present, ChatGPT-4 may not be a substitute for physicians in consultations for obstetric and gynecologic patients. Therefore, it is crucial to pay careful attention and conduct ongoing evaluations to ensure the quality of consultation opinions generated by ChatGPT-4.

First reported human use of wireless laparoscopic system: is it ready for prime time?

ObjectiveDuring the advent of laparoscopy, surgeons directly explored the abdominal cavity with a telescope-like device through a small incision. Since then, numerous technological advances have transformed minimally invasive surgery (MIS). Yet, in our wireless world, various devices crowd the surgical field, with long wires and light sources posing fall and fire risks. The primary objective of this study was to analyze the first reported human use of a novel wireless laparoscopy system or WLS (ArthroFree™, Lazurite®, Cleveland, Ohio).MethodsThe utility and convenience of the WLS was assessed via two avenues: (1) by analyzing surgical outcomes from first human use and (2) by surveying healthcare professionals regarding its quality and utility.ResultsEighteen patients (mean age 44.2, 83.3% female, mean BMI 33.4) underwent operations with the WLS. Operations included gynecologic and general surgical procedures. There were no intraoperative or postoperative complications, and no conversions to traditional laparoscopy or laparotomy. Mean operating time was 71.94 ± 20.41 min, and estimated blood loss was minimal. Survey results revealed varied individual experiences. Strengths included adequate illumination, improved ergonomics, and simplicity of setup and ease of operation. One respondent criticized the image resolution. Feedback indicated an overall positive impact, and 67% of respondents supported inclusion of the device at their facility. Moreover, its deployment in resource-limited settings abroad has demonstrated its efficacy in global surgery, indicating its potential in various healthcare environments.ConclusionsThis is the first reported human use of a novel WLS. Clinical results supported efficiency and safety of the technology. The successful deployment of the WLS in diverse surgical environments, including resource-limited settings, highlights its potential as a universally adaptable tool in global surgery. This report represents a strong first step toward a wireless operating room with the promise of redefining surgical standards as well as bridging gaps in surgical care worldwide.Graphical abstract

Examination Of Nursing and Midwifery Theses In The Field of Gynecologic and Obstetric Surgery: A Thesis Mappıng Example In Turkey

Examination Of Nursing and Midwifery Theses In The Field of Gynecologic and Obstetric Surgery: A Thesis Mappıng Example In Turkey

Implementation and outcomes in benign gynecological surgery with HUGO™ RAS system 12 months initial experience

We share our experience with the Hugo™ Robotic-Assisted Surgery system in benign gynecological surgeries. We retrospectively analyzed patients who underwent elective robotic surgeries for benign gynecological conditions at our surgical center from February 2023 to February 2024. Data collected included patient demographics, surgery indications, and outcomes. Perioperative data on port-placement time, arm configurations, docking, and console time were documented. Procedural outcome data including troubleshooting and overall satisfaction were also recorded. The primary outcome was perioperative data on port placement, docking time, arm configuration, and console time. The secondary outcome was defined as team satisfaction, system troubleshooting, arm repositioning, and complications graded 3–4 on the Clavien–Dindo Scale. A total of 60 patients underwent procedures for benign gynecological conditions using the Hugo™ RAS over the 12-month study period, primarily for pelvic endometriosis (53%), hysterectomies (27%), and adnexal surgery (10%). The mean port-placement time was 13 min and 41 s. In 31% of cases, low-port placement was used, with arm positioning being asymmetrical in 63% and symmetrical in 37%, demonstrating the system’s flexibility in customizing port configurations while optimizing cosmetic outcomes. Docking time averaged 5 min and 51 s, and console time was 1 h and 5 min. Operational challenges included arm tremors and limited workspace for the assistant. This study details our knowledge using the Hugo™ RAS. Learning curves of port placement, arm positioning, docking, and procedure time can be rapidly adapted in a well-trained team. Our experience suggests the technology is still in its learning curve period.

Seeing is believing: Patients’ attitudes and information preferences towards robotic gynaecological surgery

ObjectivesRobotic gynaecological surgery (RS) is reported to be associated with feelings of apprehension and anxiety pre-operatively in a proportion of patients. This study aimed to investigate patients’ understanding and perceptions towards RS, and whether the format of RS information resources could improve acceptability of RS. DesignA two-phase, sequential, mixed methods study involving semi-structured interviews of patients who had previously undergone gynaecological RS and a block-randomised crossover study of women from the general public. Qualitative data from interviews were analysed using thematic analysis, quantitative data from questionnaires were summarised and analysed using Mann-Whitney U and Fisher's exact tests. ResultsInterview participants reported very little background knowledge of RS prior to their surgery. Many participants stated that written information leaflets did not adequately describe the robotic set-up and procedure, leading to anxiety and information seeking from alternative sources. The use of videos or models to visually demonstrate how the surgery would be performed and the interaction between the surgeon and the robot were proposed to address patients’ needs. Questionnaire data from 30 women demonstrated an increase in acceptability of RS following provision of information, with 73.3 % of the participants reporting that the video alone was an adequate source of information, compared to only 46.7 % for the printed leaflet. ConclusionThis study gives new insights into the impact of information provision for patients undergoing RS. Availability of information resources in different modality formats, in particular an information video, may help address patients’ information needs, reduce anxiety and hence increase acceptability of RS.

Ergonomic and sustainable posture for gynecological laparoscopic surgeons determined based on images analyzed using artificial intelligence.

Studies have reported the emergence of work-related musculoskeletal disorders (WMSD) due to surgery. In fact, the usfige of long-shafted instruments has been suspected to induce WMSD in laparoscopic surgery. The present study therefore investigated whether differences in the range of motion of the face and neck, and the shoulder, elbow and hand on the dominant hand side, existed when using short- and long-shafted laparoscopic coagulation shears (LCS) during a gynecological laparoscopic surgery, based on images analyzed using artificial intelligence. After identifying the corresponding body parts in the video, the range of motion was illustrated graphically for each joint coordinate, followed by statistical analysis for changes in the position of each part. The range of motion for the face and neck did not significantly differ, whereas those for the shoulder, elbow and hand became noticeably broader when using the 36-cm long-shafted LCS than when using the 20-cm short-shafted LCS. Overall, the shorter LCS promoted a narrower range of motion compared with the 36-cm LCS, suggesting its potential for reducing the physical strain placed on the surgeon's body during gynecological laparoscopic surgery.

This is the first in‐human trial and prospective case series of a novel single‐port robotic system for gynaecological surgery: An IDEAL stage 2a study

AbstractBackgroundThe Shurui® system (SR‐ENS‐600) is a novel fully integrated single‐port robotic system with bioinspired serpentine surgical manipulators and a camera.MethodsThis was a single‐centre prospective case‐series study according to the IDEAL stage 2a guidelines to evaluate the feasibility, safety and potential efficacy of the Shurui® system for gynaecological surgeries and to improve the operating process.ResultsTen patients with a gradient of surgical difficulty who had indications for laparoscopic surgery and who volunteered to participate in a clinical trial were enrolled in the study. All 10 subjects successfully completed the procedure without converting to other procedures. No serious complications were reported at the 3‐month follow‐up. Subjects recover faster after surgery and are highly satisfied with the incision.ConclusionsGynaecological single‐site laparoscopic surgery with the Shurui® system was technically feasible for well‐selected patients with minimal alterations in technique. Further prospective multicenter large‐sample studies are necessary.Registration numberChiCTR2300075431. URL: https://www.chictr.org.cn/showproj.html?proj=189995.

Too big to bag? - Technique for bagging very large adnexal masses via vNOTES

The technique to perform adnexectomy for adnexal masses has shifted over the last decades, from open surgery towards minimally invasive approaches. At the same time caution is warranted to prevent perioperative intra-abdominal spilling of cyst content which can be a challenge especially for very large masses. vNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery) combines a vaginal approach with endoscopic overview in performing gynaecological surgery without abdominal scarring. The aim of the video is to demonstrate a vNOTES technique for safely bagging very large adnexal masses.

Early surgical outcomes of 550 consecutive patients treated for benign gynecological conditions by transvaginal natural orifice transluminal endoscopic surgery.

Evidence about intra- and postoperative complication rates related to transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynecological conditions is still limited. We report and analyze data from a large cohort of patients operated in a single institution during 3.5 years. To evaluate the safety and feasibility of vNOTES for benign gynecological indications, we performed a single-center observational study reporting and analyzing perioperative outcomes of 550 consecutive patients operated between 2020 and 2024. Of the 550 included patients, 365 (66.4%) underwent a vNOTES hysterectomy, 167 (30.4%) a procedure limited to the adnexa, and 18 (3.3%) other interventions, including myomectomy, pelvic adhesiolysis, post-hysterectomy pelvic hematoma drainage, pelvic organ prolapse repair, and appendectomy. The mean age was 49.4 ± 12.2 years, and the mean BMI was 26.2 ± 5.8 kg/m2. The total complication rate was 6.5% (36 cases), of which 2.7% (15 cases) were intraoperative complications and 4.0% (22 cases) were postoperative complications. Patients presented postoperative complications classified as Clavien-Dindo (CD) grade I in 4 cases (0.7%), grade II in 10 cases (1.8%), and grade III in 8 cases (1.5%). We observed no CD grade IV and V complications. Three patients (0.5%) were rehospitalized for postoperative complications management. The conversion rate was 1.6%, with nine cases of conversion to conventional laparoscopy and none to laparotomy. The application of vNOTES appears safe and feasible for most benign gynecological surgeries. Our study focused on surgical complications and demonstrated a profile similar to those reported in previous studies.

Confocal Laser Endomicroscopy as a method for assessing endometriosis: A pilot study

ObjectivesTo validate probe-based Confocal Laser Endomicroscopy (pCLE) as a method in assessing endometriosis during conventional and robot-assisted laparoscopy. Study DesignPilot study, including five women in Hospital Moriah, São Paulo, Brazil. During laparoscopic procedures, pCLE was used to assess endometriosis lesions, complemented by subsequent histological evaluations. 214 optical biopsies were performed. These assessments contributed to the development of a comparative atlas, which was used by surgeons to respond to a questionnaire to identify specific cellular structures related to endometriosis in selected confocal images. ResultsThe patients had an average age of 35, exhibiting predominant symptoms like dysmenorrhea and dyspareunia. Despite varied familiarity with pCLE, surgeons demonstrated positive acceptance of the method, with 63.1% recommending its use for intraoperative diagnosis. The technique was particularly noted for its ability to provide real-time, detailed images aiding the identification of endometriosis and associated structures like adipocytes and vascularization, with average evaluation scores exceeding 8 of 10. ConclusionsThis study underscores pCLE’s potential as a transformative diagnostic tool in minimally invasive gynecological surgery. It highlights the feasibility and initial acceptance among surgeons, emphasizing the need for further improvements in device durability and cost-effectiveness. pCLE promises significant advancements in the diagnosis and management of endometriosis, suggesting a future direction for clinical applications and technological refinement.

Application of the mesh bridging technique in the excision of abdominal endometriosis lesions: Case report and literature review.

Abdominal wall scar endometriosis (AWE) is a rare endometriosis that usually occurs after gynecological or obstetric surgery and for which surgical resection is the standard treatment. For large tissue defects after resection, abdominal wall reconstruction is needed. Here, we describe a mesh bridging technique using biological and polypropylene meshes for abdominal wall reconstruction. A 34-year-old woman visited the center with complaints of low abdominal wall pain during menstruation for more than 5 years. Her surgical history included undergoing a cesarean section delivery twice. A mass measuring 6 cm × 5 cm × 3 cm was found above the symphysis pubis in the lower part of the abdominal incision. Endometriosis lesion was considered based on abdominal ultrasound and magnetic resonance imaging findings. After a multidisciplinary discussion that included surgical experts and gynecologists, the decision was made to perform abdominal endometrial focus excision plus abdominal wall reconstruction. Two kinds of mesh were skillfully used in the operation of this patient. Biological mesh was used close to the peritoneal side and covered with polypropylene mesh to reduce the stimulation by the polypropylene mesh of the peritoneum, enhance the strength of the biological mesh, and reduce the incidence of abdominal wall hernia. Our case demonstrates that accurate diagnosis of AWE followed by complete resection and reconstruction of the abdominal wall using a combination of biological and polypropylene mesh bridging can achieve good therapeutic results and patient satisfaction.

Adhesion barriers in gynecologic surgeries and cesarean section: An Asia-Pacific expert panel consensus recommendation.

Adhesions arising from gynecologic surgeries and cesarean sections pose substantial clinical, social, and economic challenges, leading to issues like pelvic pain, infertility, bowel obstruction, and recurring surgeries. Preventing adhesions is a pressing unmet need, hindered by difficulties in assessing postoperative adhesions and understanding barriers. To bridge adhesion prevention gaps, statements on clinical practices were synthesized to present Asia-Pacific expert perspectives on gynecologic surgery and cesarean section adhesion prevention. An expert panel of eight physicians from various healthcare settings in the Asia-Pacific region was convened and a comprehensive literature search on topics related to adhesion prevention in gynecologic surgeries and cesarean sections was performed. Information from full-text publications was used to develop draft consensus statements, with each statement assigned the highest available evidence level based on a systematic literature review and graded using the Oxford Center for Evidence-based Medicine criteria. A modified Delphi process, involving two rounds of online voting and discussions with an extended group of 109 experts, was employed to reach a consensus on six topics related to adhesion barriers. A set of 15 consensus statements were synthesized. Key topics include adhesion incidence in Asia, cesarean section complications, barrier application status, adhesion formation and prevention, absorbable barriers' effectiveness, recommendations, and future considerations. The statements provide guidance for healthcare professionals, especially in the Asia-Pacific region, to tackle the challenges posed by postoperative adhesions and improve patient outcomes. Further research is needed to enhance understanding and prevention of adhesions in this region.

The Legacy of James Marion Sims: History Revisited.

The title "Father of Modern Gynecology" is often attributed to Dr James Marion Sims, a pioneering American physician whose contributions to gynecology have profoundly influenced modern medical practice. Born in 1813, Sims developed several innovative surgical techniques and instruments that revolutionized the treatment of gynecological conditions. Among his most notable contributions is the Sims speculum, which remains a fundamental tool in gynecological examinations today. Sims is also credited with pioneering surgical techniques for repairing VVFs, previously deemed untreatable. His work, primarily conducted in the mid-19th century, laid the foundation for modern gynecological surgery and significantly advanced women's healthcare.However, Sims' legacy is also marked by ethical controversy. His early research involved experimental surgeries on enslaved African-American women, conducted without the use of anesthesia. These practices have sparked critical discussions regarding medical ethics, informed consent, and the historical exploitation of marginalized groups under the guise of scientific progress. This review article explores the dual facets of James Marion Sims' legacy, acknowledging his crucial role in shaping modern gynecology while critically examining the ethical implications of his methods. Such a discussion is vital for understanding the evolution of medical practices and the ongoing need for stringent ethical standards in clinical research and patient care.

Effect of sugammadex with neostigmine on postoperative bowel function and on recovery of neuromuscular functions: A randomized controlled trial.

Early recovery of neuromuscular and bowel function after abdominal surgery are important clinical indicators of postoperative recovery. This study aimed to investigate the effects of sugammadex, and neostigmine added to sugammadex, on postoperative bowel function and recovery from neuromuscular blocking agents. Ninety gynecological surgery patients, aged 18 to 65 years, with American Society of Anesthesiologists of 1 to 2 were randomly assigned to 3 groups: sugammadex 2 mg/kg (Group S), sugammadex 1 m/kg with neostigmine 20 µg/kg + atropine 10 µg/kg (Group S1N), and sugammadex 1.5 mg/kg with neostigmine 20 µg/kg + atropine 10 µg/kg (Group S2N), for reversal at the end of surgery during moderate block (train-of-four [TOF] count 1-2). Propofol, remifentanil, rocuronium, and sevoflurane were used for general anesthesia, and neuromuscular function was assessed using kinemyography. The primary outcomes assessed the effects of sugammadex alone and in combination with neostigmine on the time to first flatus. The secondary outcomes included time to first defecation and recovery time; defined as the administration of reversal agent to TOF ratio 90%. Data from 90 female patients who underwent abdominal gynecological surgery were analyzed. No significant differences were found between the groups in term of the time to first flatus, defecation, or postoperative nausea and vomiting after surgery. However, significant differences were observed in the time to reach a TOF ratio 90% (P < .001) and extubation time (P = .003). The addition of neostigmine to sugammadex did not affect bowel function recovery. However, combining 20 μg/kg neostigmine with 1.5 mg/kg sugammadex or 2 mg/kg sugammadex alone antagonized moderate-depth nondepolarizing neuromuscular blockade with similar efficacy.

Surgeon stress, anxiety, and workload: a descriptive study of participant reported responses to fundamentals of laparoscopic surgery exercises

BackgroundStress while operating is an important contributor to surgeon health and burnout. Measuring stress is key to improving surgeon and patient outcomes, however biological responses to stress during surgery are variable and difficult to interpret. Participant reported measures of stress have been suggested as an alternative, but the most appropriate measure has not been defined. This study’s primary aim was to assess measures of anxiety, stress, and workload before and after surgical simulation and characterize the relationship between these measures.MethodsSurgeons completed three laparoscopic exercises from the fundamentals of laparoscopy program (peg transfer, pattern cutting, intracorporeal suturing) in a neutral environment and “stressed” environment (ergonomic, noise, or time pressure). State trait anxiety and self-reported stress on a visual analogue scale were collected prior to simulation and again immediately afterwards. The NASA task load index (TLX) was also administered post-simulation.ResultsOf the 26 participants from gynecological and general surgery specialties, state anxiety increased in 98/148 simulations (62%) with a significant mean increase during simulation (32.9 ± 7.9 vs 39.4 ± 10.2, p < .001). Self-reported stress increased in 107/148 simulations (72%), with a significant increase in mean scores during simulation (38.7 ± 22.5 vs 48.9 ± 23.7, p < .001). NASA-TLX scores immediately after simulation ranged from 40 to 118 (mean 60.5 ± 28.7). Greater anxiety and stress scores were reported in “stressed” simulations (43.6 ± 23.1 vs 54.2 ± 23.3; 68.7 ± 27.0 vs 52.4 ± 28.2 respectively) with a significant interaction effect of the “stressed” environment and type of exercise. Anxiety and stress were moderately positively correlated prior to simulation (r = .40) and strongly positively correlated post-simulation (r = .70), however only stress was strongly correlated to workload (r = .79).ConclusionStress and anxiety varied by type of laparoscopic exercise and simulation environment. Correlations between anxiety and stress are stronger post-simulation than prior to simulation. Stress, but not anxiety, is highly correlated with workload.Graphical