Does sleep deprivation alter virtual reality-based robotic surgical skills?

Abstract

Introduction: Robotic surgery is widely used in many surgical specialities, and there has been no study to assess the impact of sleep deprivation on the complex environment of robotic surgery. Aim: To compare specific metrics of selected robotic simulator exercises on sleep-deprived and non-sleep-deprived surgical residents. Material and methods: We enrolled 20 volunteers, residents in surgery, evaluated before and after an 18-hour overnight shift, regarding their results on virtual robotic surgery simulator-the sleep deprivation (SD) group. As a control group, the same subjects were evaluated 5-7 days after the post-shift evaluation, without having a shift overnight and at least 7 h of sleep the previous night-the non-sleep-deprivation (nSD) group. Results: A statistically significant difference between the pre-shift and post-shift overall results for all exercises in the SD group and no statistical differences for the nSD group were observed. As the difficulty of the exercises increased, statistical differences were observed on specific metrics for all exercises between the pre-shift and post-shift as well as between the post-shift and the morning after a normal sleep period overnight. In a subgroup analysis, the overall results revealed a stronger statistical difference between pre-shift and post-shift for residents with more intense sleep deprivation (< 3 h of sleep vs. > 3 h of sleep). Conclusions: Sleep deprivation leads to impairment of surgical skills assessed by robotic virtual simulator. The more complex and skill demanding the exercise, the higher the difference between sleep deprived and non-deprived residents.

Insomnia—A Systematic Review and Comparison of Medical Resident’s Average Off-Call Sleep Times

“…As aforementioned, the data concerning a decrease in surgical skills in sleep deprived residents are conflicting. It is also of note that all of the papers citing a decline in surgical skills when sleep deprived measured skill level using various simulated tasks [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]24,[58][59][60][61][62][63][64][65][66][67][68]. These findings may not be directly transferrable to actual everyday surgeries, as surgeons are rarely operating alone in these situations, so mistakes may be caught or corrected by colleagues.…”

“…Crucially, the available literature evaluating surgical performance when sleep deprived is very conflicting. Many studies show a decrease in performance when surgeons are asked to perform various simulated surgical tasks post call [6][7][8][9][10][11][12][13][14][15][16]. A systematic review of the effects of acute sleep deprivation on surgeons found that of the 21 papers analyzed, 12 showed a negative effect on surgical skills [17].…”

The impact of tiredness on virtual reality robotic surgical skills.

“…This can be explained by the role of working memory. The working memory was described in sleep-deprivation studies as keeping task-relevant information for a few seconds in order to be used for routine ongoing activities, and it has been proved that it is not always affected by sleep deprivation/ tiredness [22,23].…”

Assessment of training and selected factors on speed and quality of performing different tasks on the endoscopic simulator.

“…During the university classes, medical students have practically no contact with the laparoscope, apart from observing the procedures carried out by older, experienced surgeons. Medical students and young adepts of orthopaedics and surgery should have constant contact with laparoscopic trainers [21][22][23].…”

“…Cumpanas et al [ 21 ] examined how sleep deprivation influenced performance on the robotic virtual reality simulator. In their research sleep deprivation does not influence the time of performance on easier tasks but influences time of performing more difficult tasks.…”