Background: This study examines the effect of alcohol intake on surgical dexterity immediately after and the morning after alcohol intake and minimal sleep deprivation by simulating a typical night out on the town.

Methods: Five surgeons (all men, aged 31-40 years) were trained on a laparoscopic surgical simulator (minimally invasive surgical trainer-virtual reality) to reach a desired standard of performance. Three experimental settings were used: (i) a control night with no alcohol and full night's sleep; (ii) a sham night out (sleep deprived) without alcohol; and (iii) a night out with alcohol ad libitum. The parameters recorded were the average time taken to carry out a task, error rate, average diathermy time and diathermy (damage) time to main object. Comparisons between baseline readings, those in the middle of the night and those of the following morning were made by applying ANOVA methods after logarithmic transformation of the data.

Results: The candidates consumed, on average, 10.33 units (range, 6-15 units) of alcohol and had 0.86% (range, 0.71-1.1%) of breath alcohol levels and an average of 3.75 h (range, 3-5 h) of sleep after a typical night out. The morning-after breath alcohol levels were 0%. There was significant deterioration in performance, as measured by all indicators, immediately after alcohol consumption. The adverse effects on time taken to complete the task and total diathermy time were still apparent the morning after. The sham night out appeared to affect only 'time parameters'. No significant changes in performance were seen in the control setting.

Conclusion: Both alcohol consumption and sleep deprivation adversely affect the ability to carry out surgical procedures. Our simulation study suggests that the adverse effects of alcohol intake persist the following morning.