Does sleep deprivation alter virtual reality-based robotic surgical skills?

Introduction: Robotic surgery is widely used in many surgical specialities, and there has been no study to assess the impact of sleep deprivation on the complex environment of robotic surgery. Aim: To compare specific metrics of selected robotic simulator exercises on sleep-deprived and non-sleep-deprived surgical residents. Material and methods: We enrolled 20 volunteers, residents in surgery, evaluated before and after an 18-hour overnight shift, regarding their results on virtual robotic surgery simulator - the sleep deprivation (SD) group. As a control group, the same subjects were evaluated 5-7 days after the post-shift evaluation, without having a shift overnight and at least 7 h of sleep the previous night - the non-sleep-deprivation (nSD) group. Results: A statistically significant difference between the pre-shift and post-shift overall results for all exercises in the SD group and no statistical differences for the nSD group were observed. As the difficulty of the exercises increased, statistical differences were observed on specific metrics for all exercises between the pre-shift and post-shift as well as between the post-shift and the morning after a normal sleep period overnight. In a subgroup analysis, the overall results revealed a stronger statistical difference between pre-shift and post-shift for residents with more intense sleep deprivation (< 3 h of sleep vs. > 3 h of sleep). Conclusions: Sleep deprivation leads to impairment of surgical skills assessed by robotic virtual simulator. The more complex and skill demanding the exercise, the higher the difference between sleep deprived and non-deprived residents.