Heart Rate and Heart Rate Variability as Indicators for Stress and Skill Development in Minimally-Invasive Surgery

The acceptance of surgical assistance systems is highly dependent on their ability to dynamically adapt the level of assistance to the surgeon's individual needs. The challenge is to assess the skill level across a variety of surgical tasks. Intra-operative stress measurement could present an opportunity for task-independent skill assessment, with the hypothesis that challenging situations lead to higher stress levels. In this paper, we investigate the relationship between physiological and subjective measures of stress and surgical performance in a simulator setting. To this end, we collected heart rate as well as mental load self-assessment data of ten participants during repetitive training sessions of a minimally-invasive surgery curriculum. We explore the training effects on stress levels across different time scales and show a clear relationship between experienced stress and surgical performance. Our results indicate that intra-operative stress assessment could play a key role in designing adaptive surgical assistance systems.Clinical relevance - Our research offers a new approach to allow assistance systems to adapt to the surgeon's skill level. Thus, it holds the potential to increase the acceptance of these systems, ultimately leading to more reliable clinical outcomes. Furthermore, the collected data provides valuable insights into the relationship between training progress, skill level and stress. This could function as a basis for more advanced surgical training tools.