SP5.11 - The Impact of Total Pelvic Exenteration on Surgeon Fatigue: Is it time we monitor our surgeons?

Abstract Aims Total pelvic exenteration surgery (TPE) is a radical procedure requiring significant surgeon mental and physical stamina. Literature surrounding surgeon fatigue remains minimal. This study investigated impact of performing high complexity TPE on surgeon fatigue. Methods Two surgeons ([#1]/[#2]) delivering high complexity TPEs between 1st November 2022 – 1st September 2023 in a tertiary centre (110/annum) were assessed using a predefined protocol. Surgeon heart rate, concentration performance (d2 Brickencamp test) and Surgery Task Load Index (SURG-TLX) were measured across intraoperative stages (mobilisation, dissection, reconstruction). Surgeons underwent baseline cardiopulmonary exercise testing. Results All-cause mortality rate was 0% at median follow up of 3 (1-11) months. Baseline VO2 max and anaerobic thresholds: #1 = 37.6 mL/kg/min, 50% and #2 = 54.3 mL/kg/min, 70%. Mean error rate (ER): d2 test 1 and 2: #1 = 3.58% [0.91%–8.60%] [SD = 3.16, 95% CI = 0.27 to 6.91], #2 = 4.46% [1.37%–7.23%] [SD = 2.55, 95% CI = 1.79 to 7.14]. Greater HR deviation correlated with higher test 2 ER for both subjects (p>0.05). During dissection, mean HR increased from baseline: mean of 70% [#1] and 51.9% [#2]; max HR 106.7% [#1] and 111.5% [#2]. Subjects demonstrated smaller mean HR increase from baseline during dissection operating together versus with junior trainees (#1 = 46.7% [p< 0.001] and #2 = 48.1% [p>0.05]). SURG-TLX situational stress domain was most impacted. Conclusions Surgeon HR fluctuations corresponded with significant intraoperative events. Assistant dependent HR fluctuation and increased average d2 ER was demonstrated by greater HR deviations during dissection. Further investigation optimising strategies minimising surgeon fatigue is required.