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23-01-2013 | Surgery | Article

Micro-breaks could enhance surgical performance


Free abstract

medwireNews: Enforced active micro-breaks during long operations help to combat fatigue and maintain strength and even preserve surgical precision, say researchers.

The study shows that surgeons' strength and precision suffer during long operations. "More importantly, it also found a solution to this problem," say the researchers, Dominique Dorion and Simon Darveau, from the University of Sherbrooke in Quebec, Canada.

The "micropauses" occurred every 20 minutes, and lasted for just 20 seconds each, during which the 16 surgeons in the study had to step away from their work and stretch their neck and shoulders. While initially skeptical, believing that micropauses would interrupt their workflow, the participants became positive.

"The consensus was that early in the operation, pauses seemed to be coming too frequently," writes the team in the Annals of Surgery. "After the first hour on the other hand the regular breaks were welcome and even anticipated."

The micropauses were used during common operations lasting at least 2 hours, and cut surgeons' subjective fatigue by about half, compared with that reported after the same operation conducted without micropauses. For example, scores for back discomfort were about 50 versus 25 mm on a 100 mm Likert scale.

But to the researchers' surprise, most of the surgeons did not continue to use micropauses after completing the study.

"The reasons for this low compliance are not easy to identify, but they probably include a feeling of invincibility, a lack of awareness, a touch of laziness, and a leave-me-alone attitude," say Dorion and Darveau. "In summary, we are dealing with surgeons."

They say that the circulating nurse must enforce the micropauses, and first-time users of micropauses should do so on longer, more complex operations, "where the benefits will be immediately palpable."

Muscle strength, measured as the length of time the surgeons could hold up a 2.5 kg weight using their dominant arm prior to surgery, was unaffected by an operation with micropauses, but was 33% reduced when micropauses were not used.

Furthermore, operating without micropauses had a large effect on surgeons' precision, measured by their ability to follow a star-shaped track with a pair of Metzenbaum scissors without touching the border of the track. They made an average of one error before surgery, approaching two after surgery with micropauses, but nearly eight after surgery without micropauses.

"Although hoped-for, results from the accuracy test came as a shock," say Dorion and Darveau.

They concede that it is not clear how this would translate into real-life surgical precision, and note that the surgeons' awareness of the intervention could have biased the results.

But they say: "We challenge anyone to find a surgeon who would knowingly or subconsciously attempt to look clumsy with a pair of Metzenbaum scissors."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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