News items Doctor Bob: alcohol impairs surgical skills

25 April 2024

The more alcohol someone has consumed, the worse their score on a surgical skills test. This is shown by Radboud university medical center based on the Doctor Bob study conducted at Lowlands Science. ‘It would be beneficial for many countries to tighten their guidelines regarding alcohol use among surgical specialists.’

Surgeons, medical residents, and students from Radboudumc conducted scientific research in a rather unique setting in 2022, amidst festival tents pulsing with beats at Lowlands Science. They assessed the blood alcohol concentration of 1056 Lowlands attendees using a breathalyzer and then had them perform a surgical instrument test to investigate the effects of alcohol on surgical skills.

Participants were given two instruments: a grasper with hooks used by surgeons to hold tissues, and a curved clamp used by physicians to grasp objects. These instruments are utilized by surgeons for laparoscopic surgery, where operations are performed through small incisions in the skin, avoiding the need for open surgery. Participants were tasked with moving rings from one side to the other using these tools for three minutes.


The test proved to be quite challenging, with participants on average only managing to move two rings to the other side. The group with the highest blood alcohol concentration included a relatively high number of men, but gender did not affect performance on the test. However, the results showed that surgical task performance deteriorated as blood alcohol concentration increased.

Medical specialists consume more alcohol than the general population, and those in surgical professions even more. Additionally, people tend to underestimate both their alcohol intake and the duration of its effects. Medical student Daan Verhoeven: ‘If you've been drinking heavily at a party late into the night, you shouldn't be getting behind the wheel in the morning. Few people realize that.’


The Netherlands is the only Western country where guidelines state that surgeons must adhere to a zero-tolerance policy for alcohol consumption while on duty. However, different rules apply if the surgeon is on call as backup. In such cases, the surgeon must adhere to the same standard as for driving a car, which in the Netherlands is a maximum of 0.5 per mille blood alcohol concentration. This roughly translates to 1.5 drinks for women and 2.5 drinks for men.

In other countries, the rules are less stringent. For example, guidelines in countries like the US, UK, and Australia stipulate that a surgeon should not appear at work if alcohol negatively affects their performance. ‘That's a vague rule. When exactly is that?’ asks pediatric surgeon Bas Verhoeven. ‘It would be beneficial for these countries to tighten the guidelines for alcohol use among surgical specialists. Globally, we would prefer to see: zero tolerance is the standard.’

About the Publication

This study was published in Heliyon: Alcohol’s impact on fine motor skills: insights from minimally invasive surgical simulation. Daan J Verhoeven, Bas H Verhoeven, Sanne MBI Botden, Ivo de Blaauw, Maja Joosten.

More information

Annemarie Eek


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