The evaluation of oxidative stress as an indirect marker of the surgeon’s intraoperative stress during laparoscopic colorectal surgeries

Fumihiko Fujita, MD, PhD, FACS, Yasuhiro Torashima, MD, PhD, Chika Sakimura, MD, Yusuke Inoue, MD, Daisuke Kawahara, MD, Akira Yoneda, MD, PhD, Kengo Kanetaka, MD, PhD, FACS, Mitsuhisa Takatsuki, MD, PhD, FACS, Shigeki Minami, MD, PhD, Tamotsu Kuroki, MD, PhD, FACS, Susumu Eguchi, MD, PhD, FACS. Department of Surgery, Nagasaki Graduate School of Biomedical Sciences.

Introduction: Although physical and mental fatigue may affect surgeons during surgery, few studies have so far evaluated the surgeon’s stress objectively. The purpose of this study was to investigate the burden on the surgeon while performing an operation. We selected biomarkers of oxidative stress as indicators of a breakdown of the normal physiological balance.

Methods: One surgeon with 18 years of experience was evaluated in this study. Blood samples were collected from the surgeon before and after the operations, and the serum Diacron-reactive oxygen metabolites (d-ROMs) and Biological Antioxidant Potential (BAP) were measured to assess the levels of oxidative stress.

Results: Twenty-five consecutive laparoscopic surgeries for colorectal cancer were evaluated in this study. The surgeon participated in the operations as an operator in nine ases and as an assistant in 14 cases. In all of the cases, the serum level of d-ROMs was significantly increased after surgery compared with that before surgery (p=0.017), while the BAP did not change. The d-ROM level dramatically increased in the cases where he was the operator (p=0.006). In the cases where he was the assistant surgeon, there were no statistically significant differences between the d-ROM and BAP levels before and after the surgeries. We could not find any significant correlation between the length of the operation or the estimated blood loss of the patient and the oxidative stress in the surgeon in this series.

Conclusions: A surgeon may suffer from oxidative stress during surgery, especially when serving as the operator. Additional studies in a large number of surgeons in different fields are therefore warranted.

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