To our knowledge, this is the largest published study to date assessing the effect of preferred music on laparoscopic surgical performance in a simulated setting and the first to use participant-preferred music during simulated laparoscopic task performance . Participants performed the laparoscopic task on average 4.68% faster, and their instrument handling was more efficient, as the path length was reduced by 6.35% during exposure to music of their choice. To our knowledge, this is also the first published study that observed a beneficial effect of music on mental workload, as it was significantly reduced during exposure to music. The beneficial effect of music was most profound on situational stress, physical demands and task complexity subscales. Therefore, both laparoscopic surgical task performance and the subjective experience of the participants were significantly improved during music exposure.
In surveys assessing healthcare provider’s attitudes toward music in the operating room, the operating room staff reported that music made them feel less stressed and a majority considered music not distracting [2, 20]. In the present study using a simulated setting, we observed similar effects. Music reduced the situational stress and was not found to be distracting. In fact, a majority of our cohort experienced music as less distracting than silence. The present observations using participant-preferred music confirm earlier observations by Miskovic et al. , who observed a trend toward a statistically significant beneficial effect on laparoscopic surgical performance when participants considered the researcher-selected music as pleasant. Our results confirm earlier suggestions that participant-preferred music improves simulated surgical performance . Perioperative music has been observed to reduce stress in patients undergoing surgery . We observed comparable effects during laparoscopic surgical task performance when participants were exposed to music in situational stress. High levels of stress and anxiety in the operating room are associated with impaired surgical performance, team performance and an increased risk of adverse events; music might help to reduce these stress levels [22,23,24].
Preferred music reduced subjective physical demands during laparoscopic performance. This could be of importance, as surgery is a physically demanding task. Musculoskeletal disease is highly prevalent in surgeons, often leading to a leave of absence, practice restriction or even early retirement [25, 26]. High levels of workload and perceived physical demands have been associated with the incidence of musculoskeletal disease in healthcare workers [27,28,29,30].
This study has strengths and limitations. Our sample size is large compared to earlier studies that assessed the effect of music on surgical performance [5,6,7,8,9,10,11,12,13]. Our crossover design is well balanced and minimizes possible learning effects . To further reduce this effect, all participants practiced the laparoscopic task prior to the experiment to the point where it has been observed that the learning curve starts to flatten during development of our research setup. Our study assessed laparoscopic surgical performance in a simulated setting, which has been observed to translate to, and correlates with real-world surgical performance [31,32,33,34]. Music was not considered to be distracting and positively affected laparoscopic surgical task. However, music during surgery has been reported to impair team communication, which could not be assessed in our experimental setup. It cannot be ruled out that the beneficial effects we observed can be attributed to auditory stimulation and not music per se, given that the control condition was silence. As it has been reported that noise cancellation could induce anxiety in patients , it could even be possible that we observed an adverse effect of silence instead of a beneficial effect of music. Furthermore, in a live operating environment, it is hardly ever silent in the operating room . It is unclear how music would affect laparoscopic performance in a noisy environment such as the operating theatre or when controlling for another form of auditory stimulation. However, given that music is generally well liked and prevalently played during surgery, we do not believe it clinically relevant to assess the effects of other forms of auditory stimulation for surgical task performance, except recorded operating room noise. The study population consisted of medical students who were inexperienced in laparoscopy, performing a relatively simple laparoscopic peg transfer task, as it has been reported that more experienced surgeons can more effectively block out noise and music. Also, several practical barriers would hinder the inclusion of a significant number of surgeons for laparoscopic task performance in a simulated setting, like time constraints due to busy schedules. How music would affect performance and mental workload while performing more complex surgical tasks remains unclear. Unfortunately, we could not identify any personal factors that enhance or diminish the effects of music on laparoscopic surgical performance, due to our sample size.
Surgical residents report that the largest barrier to attend simulation-based training is a lack of free time . Implementing music interventions could assist surgical residents in completing their mandatory training modules more quickly and efficiently . In our opinion, future research should focus on the effects of music while controlling for the noisy environment of the operating theater and the effects of music on laparoscopic tasks with a higher level of complexity. A follow-up study is currently being conducted investigating aforementioned fields of interests (Dutch Trial Register (Trial NL7961) www.trialregister.nl/trial/7961). Also, it would be interesting to investigate the effect of music on surgical performance in more experienced surgeons, as it is hypothesized that they block out distracting noises more effectively .