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High noise levels generated by arthroscopic equipment may impair intraoperative communication and increase cognitive workload, potentially affecting surgical efficiency. Active noise-cancelling (ANC) systems combined with closed-loop communication may enhance team interaction; however, their clinical impact remains unclear. Purpose of this study is To evaluate the effect of ANC headphones and a closed-loop communication system on operative time and intraoperative team performance during arthroscopic anterior cruciate ligament (ACL) reconstruction.
This prospective, two-arm pilot randomized controlled trial included patients aged 18-50 years undergoing primary arthroscopic ACL reconstruction. Participants were randomized (1:1) into:
The anesthesia team did not use headphones to ensure continuous monitoring of patient safety.
The primary outcome was operative time (skin incision to closure). Secondary outcomes included communication quality, number of repeated or misunderstood commands, NASA-TLX workload scores, and intraoperative noise levels.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Active Noise Cancelling Group | Experimental | surgeon, assistant, and scrub nurse using ANC headphones with a closed-loop communication system |
|
| Control Group | Experimental | standard operating room conditions without headphones |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Active Noise Cancelling Close-Loop Communication | Behavioral | To evaluate the effect of ANC headphones and a closed-loop communication system on operative time and intraoperative team performance during arthroscopic anterior cruciate ligament (ACL) reconstruction. |
| Measure | Description | Time Frame |
|---|---|---|
| Operation Time | Reduce to operation time up to 12 minutes | Intraoperative period |
| Measure | Description | Time Frame |
|---|---|---|
| NASA Task Load Index (NASA-TLX) | The NASA Task Load Index (NASA-TLX) will be used to assess the perceived workload of the operating surgeon during arthroscopic rotator cuff repair. The NASA-TLX is a validated multidimensional instrument that evaluates six domains of workload: mental demand, physical demand, temporal demand, performance, effort, and frustration. Each domain is rated on a scale from 0 to 100, with higher scores indicating greater perceived workload. An overall workload score will be calculated according to the standard NASA-TLX scoring method. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| ONUR GULTEKIN, MD | FATIH SULTAN MEHMET RESEARCH AND TRANING HOSPITAL | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fatih Sultan Mehmet Training and Research Hospital | Istanbul | 34752 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32333159 | Background | Oomens P, Fu VX, Kleinrensink VEE, Kleinrensink GJ, Jeekel J. The Effects of Preferred Music on Laparoscopic Surgical Performance: A Randomized Crossover Study. World J Surg. 2020 Aug;44(8):2614-2619. doi: 10.1007/s00268-020-05523-0. | |
| 27927145 | Background | Fancourt D, Burton TM, Williamon A. The razor's edge: Australian rock music impairs men's performance when pretending to be a surgeon. Med J Aust. 2016 Dec 12;205(11):515-518. doi: 10.5694/mja16.01045. |
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Individual participant data (IPD) will not be shared.
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This is a prospective, randomized, parallel-group study comparing the using of ANC headphones combined with a closed-loop communication system with conventional communication during ACL reconstruction.
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Masking was not feasible due to the visible nature of the surgical incision during postoperative assessments. Therefore, surgeons, participants, and outcome assessors were not blinded to group allocation.
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| Conventional Communication | Behavioral | Standard operating room conditions without headphones |
|
| Immediately after completion of the surgical procedure (intraoperative assessment). |
| Number of Repeated Commands | Reducing repetative commands | Intraoperative period |
| 41087929 | Background | Wu T, Qi H, Hui K, Hu Y, Xu M, Zhou J, Duan M. Effect of noise isolation with noise-cancelling earmuffs during laparoscopic surgery on acute postoperative pain: a clinical randomised controlled trial. BMC Anesthesiol. 2025 Oct 14;25(1):498. doi: 10.1186/s12871-025-03369-4. |
| ID | Term |
|---|---|
| D000070598 | Anterior Cruciate Ligament Injuries |
| ID | Term |
|---|---|
| D007718 | Knee Injuries |
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
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