Perceptual Distortions Produce Multidimensional Stress Profiles in Novice Users of an Endoscopic Surgery Simulator

Abstract

Objectives: We determine the impact of perceptual-motor distortions on multidimensional stress dynamics in novice users of an endoscopic/laparoscopic surgery simulator during performance of a peg-transfer task. Background: Surgeons find the endoscopic/laparoscopic surgery procedure to be more mentally stressful than open surgery. This investigation was designed to identify specific stress dimensions associated with these procedures and to determine the contributions to that stress made by loss of depth information resulting from image-guided views of the surgical field and by disruption of eye-hand mapping. Because stress reactions might depend upon familiarity with these procedures, the study focused upon novice participants. Method: An endoscopic box-simulator featured in surgical training was used in conjunction with the Dundee Stress State Questionnaire, a well-validated multidimensional stress state instrument. A control group (no perceptual distortions) viewed the simulated “surgical field” directly. Two other groups viewed the surgical field through TV images in which spatial rotation of the images was absent or in which the images were rotated 90° from the actual line of sight. Results: Performance efficiency in the simulator varied inversely with the degree of perceptual-motor distortion. Reactions reflecting increased task coping were observed in all groups. These were accompanied in the image groups by negative reactions involving decreases in hedonic tone and control and confidence and an increase in tense arousal. Conclusions: Perceptual-motor distortions are sources of complex task-induced stress profiles in novices using an endoscopic surgery simulator. Application: Procedures to reduce stress in endoscopic/laparoscopic surgery trainees may benefit from knowledge regarding specific stress dimensions involved.