{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:20:18Z","timestamp":1760239218680,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T00:00:00Z","timestamp":1602892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>The use of virtual reality trainers for teaching minimally invasive surgical techniques has been established for a long time in conventional laparoscopy as well as robotic surgery. The aim of the present study was to evaluate the impact of reproducible disruptive factors on the surgeon\u2019s work. In a cross-sectional investigation, surgeons were tested with regard to the impact of different disruptive factors when doing exercises on a robotic-surgery simulator (Mimic Flex VRTM). Additionally, we collected data about the participants\u2019 professional experience, gender, age, expertise in playing an instrument, and expertise in playing video games. The data were collected during DRUS 2019 (Symposium of the German Society for Robot-assisted Urology). Forty-two surgeons attending DRUS 2019 were asked to participate in a virtual robotic stress training unit. The surgeons worked in various specialties (visceral surgery, gynecology, and urology) and had different levels of expertise. The time taken to complete the exercise (TTCE), the final score (FSC), and blood loss (BL) were measured. In the basic exercise with an interactive disruption, TTCE was significantly longer (p &lt; 0.01) and FSC significantly lower (p &lt; 0.05). No significant difference in TTCE, FSC, or BL was noted in the advanced exercise with acoustic disruption. Performance during disruption was not dependent on the level of surgical experience, gender, age, expertise in playing an instrument, or playing video games. A positive correlation was registered between self-estimation and surgical experience. Interactive disruptions have a greater impact on the performance of a surgeon than acoustic ones. Disruption affects the performance of experienced as well as inexperienced surgeons. Disruption in daily surgery should be evaluated and minimized in the interest of the patient\u2019s safety.<\/jats:p>","DOI":"10.3390\/s20205891","type":"journal-article","created":{"date-parts":[[2020,10,18]],"date-time":"2020-10-18T21:26:06Z","timestamp":1603056366000},"page":"5891","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery\u2014A Virtual Surgical Training Model"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3337-7387","authenticated-orcid":false,"given":"Magret","family":"Kr\u00fcger","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Johannes","family":"Ackermann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Daniar","family":"Osmonov","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Veronika","family":"G\u00fcnther","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Dirk","family":"Bauerschlag","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6594-5334","authenticated-orcid":false,"given":"Johannes","family":"Hensler","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str.3 (House D), 24105 Kiel, Germany"}]},{"given":"Jan-Hendrik","family":"Egberts","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Thoracic, Transplant, and Pediatric Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Sebastian","family":"Lippross","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Orthopedics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Georgios","family":"Gitas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus L\u00fcbeck, Ratzeburger Allee 160 (House A), 23538 L\u00fcbeck, Germany"}]},{"given":"Thomas","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Thoracic, Transplant, and Pediatric Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Nicolai","family":"Maass","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Klaus-Peter","family":"J\u00fcnemann","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]},{"given":"Ibrahim","family":"Alkatout","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jsurg.2016.06.007","article-title":"Integration and Validation of Hysteroscopy Simulation in the Surgical Training Curriculum","volume":"74","author":"Elessawy","year":"2017","journal-title":"J. Surg. Educ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.jsurg.2017.01.011","article-title":"2D Versus 3D in Laparoscopic Surgery by Beginners and Experts: A Randomized Controlled Trial on a Pelvitrainer in Objectively Graded Surgical Steps","volume":"74","author":"Spille","year":"2017","journal-title":"J. Surg. Educ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ijgo.2013.10.018","article-title":"Laparoscopic virtual reality simulator and box trainer in gynecology","volume":"125","author":"Akdemir","year":"2014","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1007\/s00464-015-4443-z","article-title":"A systematic review of the effect of distraction on surgeon performance: Directions for operating room policy and surgical training","volume":"30","author":"Mentis","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1001\/archsurg.2012.1480","article-title":"Realistic distractions and interruptions that impair simulated surgical performance by novice surgeons","volume":"147","author":"Feuerbacher","year":"2012","journal-title":"Arch. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1089\/lap.2006.16.94","article-title":"Effects of cognitive distraction on performance of laparoscopic surgical tasks","volume":"16","author":"Goodell","year":"2006","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.surg.2009.08.010","article-title":"The impact of environmental noise on robot-assisted laparoscopic surgical performance","volume":"147","author":"Siu","year":"2010","journal-title":"Surgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1177\/1553350610381087","article-title":"The effect of music on robot-assisted laparoscopic surgical performance","volume":"17","author":"Siu","year":"2010","journal-title":"Surg. Innov."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1002\/bjs.7496","article-title":"Adverse effect of noise in the operating theatre on surgical-site infection","volume":"98","author":"Kurmann","year":"2011","journal-title":"Br. J. Surg."},{"key":"ref_10","first-page":"5372174","article-title":"Effect of Various OR Noise on Fine Motor Skills, Cognition, and Mood","volume":"2019","author":"Rogers","year":"2019","journal-title":"Surg. Res. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3389\/fsurg.2019.00077","article-title":"Determining the Effect of External Stressors and Cognitive Distraction on Microsurgical Skills and Performance","volume":"6","author":"Carr","year":"2019","journal-title":"Front. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1097\/SLA.0b013e318250b332","article-title":"A quality improvement study on avoidable stressors and countermeasures affecting surgical motor performance and learning","volume":"255","author":"Conrad","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"132","DOI":"10.5152\/tud.2015.01112","article-title":"Analysis of the learning curve for transurethral resection of the prostate. Is there any influence of musical instrument and video game skills on surgical performance?","volume":"41","author":"Yamacake","year":"2015","journal-title":"Turk. J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1111\/ans.12992","article-title":"What are the demographic predictors in laparoscopic simulator performance?","volume":"86","author":"Lin","year":"2016","journal-title":"ANZ J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1080\/13645706.2017.1303516","article-title":"Validation of psychomotor tasks by Simbionix LAP Mentor simulator and identifying the target group","volume":"26","author":"Elessawy","year":"2017","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.ijsu.2017.07.072","article-title":"The benefits of being a video gamer in laparoscopic surgery","volume":"45","author":"Sammut","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e01315","DOI":"10.1016\/j.heliyon.2019.e01315","article-title":"Efficiency of attentional networks in musicians and non-musicians","volume":"5","author":"Medina","year":"2019","journal-title":"Heliyon"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/13645706.2016.1267018","article-title":"Influence of videogames and musical instruments on performances at a simulator for robotic surgery","volume":"26","author":"Moglia","year":"2017","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1089\/end.2015.0425","article-title":"Effect of Playing Video Games on Laparoscopic Skills Performance: A Systematic Review","volume":"30","author":"Glassman","year":"2016","journal-title":"J. Endourol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.surg.2003.12.011","article-title":"Objective evaluation of the effect of noise on the performance of a complex laparoscopic task","volume":"136","author":"Moorthy","year":"2004","journal-title":"Surgery"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1097\/SLA.0000000000001051","article-title":"The Impact of Operating Room Distractions on Stress, Workload, and Teamwork","volume":"261","author":"Wheelock","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4525","DOI":"10.1007\/s00464-019-07239-2","article-title":"Effects of surgical flow disruptions on surgeons\u2019 resources: A pilot study","volume":"34","author":"Rutkowski","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00053-009-0038-2","article-title":"Einfluss der Lernkurve auf Kurzzeitresultate nach laparoskopischer Resektion wegen Rektumkarzinom","volume":"31","author":"Ito","year":"2009","journal-title":"Coloproctology"},{"key":"ref_24","unstructured":"Sanftleben, A.E. (2014). Untersuchung der Perioperativen Morbidit\u00e4t und Mortalit\u00e4t nach Resezierenden Eingriffen des Kolons in Abh\u00e4ngigkeit von der Beruflichen Erfahrung des Operateurs. [Ph.D. Thesis, Freie Universit\u00e4t Berlin]."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1007\/s00132-014-2292-4","article-title":"Einfluss der Erfahrung des Operateurs in der H\u00fcftendoprothetik","volume":"43","author":"Zenk","year":"2014","journal-title":"Der Orthop\u00e4de"},{"key":"ref_26","first-page":"416","article-title":"Self-estimation of surgical skills and competencies based on the learning curve theory in medical residents and fellows","volume":"87","author":"Borracci","year":"2019","journal-title":"Cir. Cir."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1007\/s00132-020-03963-z","article-title":"Einfluss der institutionellen Erfahrung auf die Ergebnisse in H\u00fcft-und Knietotalendoprothetik","volume":"49","author":"Grimberg","year":"2020","journal-title":"Der Orthop\u00e4de"},{"key":"ref_28","unstructured":"(2020, September 20). Arbeitsgemeinschaft Gyn\u00e4kologische Endoskopie (AGE) e.V.. Available online: https:\/\/www.ag-endoskopie.de."},{"key":"ref_29","unstructured":"(2020, September 20). Arbeitsgemeinschaft f\u00fcr Urogyn\u00e4kologie und Plastische Beckenbodenrekonstruktion AGUB e.V.. Available online: https:\/\/www.agub.de."},{"key":"ref_30","unstructured":"(2020, September 20). European Society for Gynecological Endoscopy. Available online: https:\/\/esge.org."},{"key":"ref_31","unstructured":"Solution, M. (2020, September 20). Available online: https:\/\/mimicsimulation.com\/mscore\/."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ackermann, J., Wedel, T., Holthaus, B., Bojahr, B., Hackethal, A., Brucker, S., Biebl, M., Westermann, M., G\u00fcnther, V., and Kr\u00fcger, M. (2020). Didactic Benefits of Surgery on Body Donors during Live Surgery Events in Minimally Invasive Surgery. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092912"},{"key":"ref_33","first-page":"292","article-title":"Music experience influences laparoscopic skills performance","volume":"12","author":"Boyd","year":"2008","journal-title":"Jsls"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.jfma.2019.06.013","article-title":"Gender differences in the acquisition of suturing skills with the da Vinci surgical system","volume":"119","author":"Chiu","year":"2020","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1055\/s-0038-1626694","article-title":"Gender Comparison of Medical Student Microsurgical Skills in a Laboratory Model","volume":"34","author":"Chiang","year":"2018","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_36","unstructured":"Bundesamt, S. (2020). Bildung und Kultur\u2014Studierende an Hochschulen, Statistisches Bundesamt."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/20\/5891\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:23:18Z","timestamp":1760178198000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/20\/5891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,17]]},"references-count":36,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["s20205891"],"URL":"https:\/\/doi.org\/10.3390\/s20205891","relation":{},"ISSN":["1424-8220"],"issn-type":[{"type":"electronic","value":"1424-8220"}],"subject":[],"published":{"date-parts":[[2020,10,17]]}}}