Motion Sickness in the Operating Rooms – Effect of Minimally Invasive Techniques

Osama Alsaied, MD, Ken Yoshida, PhD, Connie C Shmitz, PhD, David Radosevich, PhD, Sayeed Ikramuddin, MD, Jeffery Chipman, MD. University of Minnesota – Department of Surgery.

Introduction:
The incidence of visually induced motion sickness in health care providers in the era of minimal invasive interventions has not been previously studied. Anecdotal reports suggest that motion sickness symptoms are more prevalent in laparoscopic and endoscopic procedures due to high visual demand during such procedures. The purpose of this study is to assess symptoms of motion sickness among health care providers during open and minimally invasive operations.

Methods:
There were 80 subjects, consisting of 31 surgeons, 16 scrub nurses, 18 circulators, and 15 anesthetists. All subjects were surveyed within 30 minutes of completing a daytime scheduled surgical procedure. Half of the subjects were involved in an open traditional operation (open=40), while the other half were involved in a minimally invasive procedure (endoscopic or laparoscopic, MIS=40). The widely used Simulator Sickness Questionnaires (SSQ, Kennedy et al., 1993) was administered to subjects in the operating room or the recovery area. Nausea, oculomotor problems, and disorientation were assessed with the SSQ’s 16 symptoms on a 4-point scale survey and a total SSQ score was calculated. Subjects’ demographics and procedure details were also collected. Averages ± standard deviations are reported. Mann-Whitney and chi-square tests were used to compare the two groups. Multiple regression analysis was performed to identify variables associated with motion sickness symptoms.

Results:
There were no significant differences among study groups in terms of age, height, weight, procedure duration, OR room temperature, subjects’ years of experience, or incidence of previous experience with motion sickness symptoms during past operations [25% (10/40) for Open, and 27.5% (11/40) for MIS (p=0.8)]. There was no difference in the number of symptoms reported just prior to the case [7.5% in either group (3/40 MIS and 3/40 in open)]. Total SSQ scores were 10±17 and 14±19 (p=0.5) for Open and MIS groups respectively, while the subscores for nausea, oculomotor and, disorientation were 7±12 and 8±12 (p=0.6), 11±17 and 13±18 (p=-.7), and 7±22 and 14±26 (p=0.3) for the Open and MIS groups respectively. While scores trended higher for MIS cases, none of the differences were significant. The best predictors of post-surgery symptoms were pre-surgery symptoms and weight (kg).

Discussion:
OR personnel may be at slightly higher risk for motion sickness symptoms during MIS procedures, and especially those susceptible to motion sickness. Previous research on body weight supports a “postural control” theory of motion sickness causation. Further investigation geared towards identifying procedures more likely to induce motions sickness is warranted. As visually demanding newer stereotactic interventions emerge, motion sickness for OR health care providers might become a more prevalent problem.
 

 Figure 1. Average total Simulator Sickness Questionnaire (SSQ) scores, SSQ subscores for nausea, oculomotor, and disorientation.   The error bars represent standard error.

Figure 1. Average total Simulator Sickness Questionnaire (SSQ) scores, SSQ subscores for nausea, oculomotor, and disorientation. The error bars represent standard error.

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