Energy Expenditure During Laparoscopic Cholecystectomy Evaluated Using the Telemetric Heart Rate Measurement

Miroslaw Szura, MD PhD, Jan M Krzak, MD, Senka Stojanovic, MD. IST DEPARTMENT OF GENERAL SURGERY JAGIELLONIAN UNIVERSITY KRAKOW POLAND, SYGEHUS LILLEBAELT KOLDING DENMARK

INTRODUCTION
Evaluating the work of a surgeon is a difficult task, on one hand being influenced by the physical demands related to work in a standing position without any possibility of rest, and on the other hand by the stress related to the necessity of decision-making during the procedure. The method of evaluating the strain by using the heart rate measurement can be applied in easy tasks or moderately difficult ones, on the basis of oxygen consumption and energy expenditure, but at the same time in those requiring considerable static power or those involving limited, well-defined group of muscles. Increase in heart rate in such cases signifies the increase in tiredness, and the stress related to the course of the procedure additionally increases the energy given off.
The aim of this study is to evaluate the energy expenditure of an experienced surgeon during the basic laparoscopic procedure.
MATERIALS AND METHODS
Involved in this study are two experienced surgeons who independently performed or assisted residents during laparoscopic cholecystectomy. Fifty cholecystectomies were analyzed, in which the experienced surgeon was randomized into one of the two roles – that of the operator (group I) and that of the assistant (group II). Eliminated from the analysis were those procedures involving conversions to laparotomy, and those in which the experienced surgeon took over the role of the operator mid-procedure. Heart rate was measured telemetrically, continuously recording the fluctuations of the heart rate, mean heart rate and total calorie burnt. Based on the data gathered, the metabolic unit of energy expenditure was calculated to kcal/kg/h.
RESULTS
Mean heart rate of the surgeon in group I was 86/min (76-93), and in group II 88/min (71-100). Maximum value of heart rate in group I was 106/min, and in group II 118/min (p=0,001). Converted to the metabolic unit, the mean energy expenditure in group I was 3,27 kcal/min, and in group II 3,17 kcal/min (p>0,05).
CONCLUSIONS
Experienced surgeon has greater heart rate fluctuations during laparoscopic cholecystectomies in which he is assisting the resident, however, the energy expenditure was similar regardless of whether he is assisting or operating independently.
 

View Poster