eMedinewS Editorial

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Bottle–to–scalpel time: a new surgical parameter for laproscopic surgeons

A new study published in April issue of Archives of Surgery has shown that experienced laparoscopic surgeons’ operating skills remain impaired as late as 4 p.m. the day after a drinking binge. The study was done by Anthony G. Gallagher, PhD, of the Royal College of Surgeons National Surgical Training Center in Dublin, Ireland.

The effects of alcohol on next–day performance were observed in both surgical novices and experienced surgeons. There are no rules or guidelines to govern consumption of alcohol the night before operative duties or to permit clear–cut recommendations for a ‘bottle–to–scalpel’ interval to be made. Alcohol consumption has acute effects on performance, but little information is available on persistence of the effects. Both acute and late effects of alcohol consumption have particular relevance to laparoscopic surgery, because the technique places considerable demands on cognitive, perceptual, and visuospatial abilities –– all known to be vulnerable to the effects of alcohol.The authors conducted two small studies involving use of a virtual reality training system for minimally invasive surgery, recruiting 16 science students and eight experienced laparoscopic surgeons.

  • In the first study, the 16 students were randomized to abstain from alcohol or to consume alcohol until subjectively intoxicated.
  • In the second study, the eight surgeons had dinner and drank until they felt intoxicated.
  • Participants in both studies completed a baseline test in the surgical simulator prior to their night out. The test consisted of six increasingly complex tasks commonly performed by laparoscopic surgeons. The eight surgeons’ blood alcohol levels were assessed by a breathalyzer immediately prior to beginning the performance phase of the study. One surgeon still had a blood alcohol level that exceeded the legal limit for driving.
  • The primary outcomes of both studies were the time to complete the tasks, mean number of errors per task, and efficiency of diathermy (mean burn time divided by optimal burn time). All participants completed the performance test three times: 9 a.m., 1 p.m., and 4 p.m.
  • In the first study, the students who abstained from alcohol and those who drank until they felt intoxicated had similar time scores. However, the alcohol group had significantly worse performance on diathermy (P=0.03) and made significantly more errors (P=0.003). An analysis of performance by time of day showed that the alcohol group required more time to complete the tasks at all test times, but the differences reached statistical significance only at 9 a.m. The authors attributed that finding to wide variability in the drinkers’ performance.
  • In the second study, the surgeons completed the tasks faster during the second assessment than during the baseline assessment. Their performance time was significantly worse at 1 p.m. (P<0.01) and returned to baseline levels by 4 p.m. The surgeons’ economy–of–diathermy scores deteriorated as the day progressed (P<0.001), and they performed significantly worse at all three test times compared with baseline (P<0.05 to P<0.01). Error scores also differed significantly from baseline (P<0.001). The surgeons made more errors at all three test times compared with the baseline test results, but the difference reached statistical significance only a 1 p.m. (P<0.001).
  • The amount of alcohol consumed by each individual and actual blood alcohol levels were not measured in either study.
  • Given the considerable cognitive, perceptual, visuospatial, and psychomotor challenges posed by modern image–guided surgical techniques, abstinence from alcohol the night before operating may be a sensible consideration for practicing surgeons.

Dr KK Aggarwal
Editor in Chief