Out of the 4 LDLT cases, the value of HF was decreased in two and the LF/HF increased in three cases (p < 0.01) during the operation compared to those before the operation. In all 5 cases of PD, the surgeon showed significantly lower HF component and higher LF/HF during operation, indicating predominance of sympathetic nervous system and increased stress, than those before the operation (p < 0.01) and these did not return to the baseline level one hour after the operation. By frequency domain method using electrocardiograph, we measured the high frequency (HF) component, representing the parasympathetic activity, and the low frequency (LF)/HF ratio, representing the sympathetic activity. Additionally, the parameters were compared in various procedures during the operations. The purpose of this study was to evaluate mental stress of surgeons before, during and after operations, especially during pancreaticoduodenectomy (PD) and living donor liver transplantation (LDLT). The heart rate variability (HRV) is the variability in the beat-to-beat interval, which has been used as parameters of stress. Surgeons often experience stress during operations. Fellows demonstrated increased levels of stress when acting as primary operators. The teaching of complex but common endocrine surgical procedures is associated with a measurable increase in mental strain of consultant surgeons, as determined by HRV. Similarly, the LF/HF ratio was significantly greater for attending surgeons when teaching (p = 0.05), suggesting an increase in mental strain. All time domain parameters of HRV increased when attending surgeons were operating, denoting more cardiac relaxation. Fellows demonstrated a higher LF/HF ratio when acting as the primary operator (p = 0.02). Energy expenditure was greater for fellows when operating (p = 0.03). There was no statistically significant difference in the mean heart rate for either group of participants regardless of role.
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HRV data were collected between October 2009 and March 2010. The overall heart rate, time, and frequency domain parameters of HRV, specifically the low frequency/high frequency (LF/HF) ratio, which was used as a measure of cardiac and mental stress, were correlated with the surgical role, particularly teaching surgical fellows at critical points. HRV was measured during dissection around the recurrent laryngeal nerve. Fellows and consultant surgeons performed 50 lobectomies as primary operator and 50 as assistants in a cross-over design. The aim of this study was to determine whether instructing surgical trainees in technically demanding procedures causes alterations in heart rate variability (HRV) and mental strain in supervising surgeons.Ī prospective study of HRV in two consultant surgeons and three endocrine surgical fellows undertaking 50 total thyroidectomy procedures was performed.