Text

Introduction: Work-related musculoskeletal disorders (WRMSD) are common among laparoscopic surgeons due to awkward and long-lasting static body postures. Including short rest periods during laparoscopic procedures has been suggested as organizational interventions to reduce WRMSD risk. To date it is unclear whether such rest periods should be rather active (e.g. stretching exercises) or passive (doing nothing). Therefore, the primary goal was to examine whether passive or/and active work breaks can reduce ratings of perceived discomfort in comparison with no work breaks. Furthermore, we aimed to examine potential differences in performance and workload across work break conditions.

Methods: Twenty-one laparoscopic surgeons (9 females,12 males) with an average experience in laparoscopic surgery of 8.5 years (SD 5.6) and a mean age of 36.6 years (SD 9.7) performed three 90-min-lasting laparoscopic simulations without and with 2.5 min passive or active work breaks after 30 min work blocks. Each 90 min simulation took place on a separate day in a balanced, randomized cross-over design. The simulation consisted of six tasks: hot wire, peg transfer, pick-and-place, pick-and-tighten, pick-and-thread, and pull-and-stick. Ratings of perceived discomfort (CR10 Borg Scale) were asked, perceived workload (NASA-TLX) was assessed, performance per subtask was objectively determined and the break interventions were evaluated (self-developed questionnaire). Then statistical analyses were performed on the rating of perceived discomfort and on specific performance outcomes.

Results: During the laparoscopic simulation ratings of perceived musculoskeletal discomfort increased over time from a mean level of 0.1 to 0.9, without statistically significant differences between conditions (p = 0.439). Concerning performance, the hot wire and peg transfer task were evaluated, but outcomes did not statistically significantly differ between conditions. The subjective evaluation concerning the break interventions among the participants showed a positive tendency towards the duration and content of active breaks compared with passive breaks. It resulted a 65% likelihood of implementing active breaks in ≥90 min-lasting laparoscopic surgeries on their own initiative.

Discussion: Positive effects of short work breaks during laparoscopic procedures on ratings of perceived discomfort, as reported by others, could not be shown by the present study. It is possible that the chosen setting of the laboratory simulation which allowed high standardization regarding the physical and cognitive workload or body postures between the three experimental conditions has contributed to this result.

Conclusion: As work breaks did not lead to performance losses, rest breaks can be investigated concerning its practicality, acceptability and effectiveness in real-life situations in future feasibility and following longitudinal (cohort) randomized controlled trials, where perceived discomfort may differ from this laboratory situation.