Conclusion
decreased shoulder muscular fatigue, musculoskeletal disorders
PHYSICAL STRESS, MUSCULOSKELETAL DISORDERS
This randomized, controlled cross-over laboratory trial demonstrated tendencies in favor of 2.5-min intraoperative work breaks presented after 30-min work blocks, including the tendencies of decreased shoulder muscular fatigue and increased heart rate variability (SDNN). The tentative results may point toward a potential relieving effect on the risk for developing musculoskeletal disorders and physical stress responses. Note that the tendencies for potential positive effects of intraoperative work breaks as detected in the here investigated simulated laparoscopy are, in a real laparoscopic surgery, highly dependent on the complexity and duration of the surgery, composition of the surgical team (enough skilled surgeons present), sequence of the surgery (first surgery or after several surgeries), and physical condition of the surgeon. The effect of passive and active breaks on perceived musculoskeletal discomfort and performance is to be evaluated in a follow-up manuscript. Following the outcomes of this study and taking in consideration the context of a real surgical laparoscopy, a field feasibility study should validate the acceptability and practicability of intraoperative active work breaks during laparoscopic procedures, after which a cluster randomized controlled trial can assess its effectiveness.