Mindfulness and surgery are concepts that are not often considered in the same thought process. Mindfulness is being aware of the present moment, and its key components are intention, presence, and nonjudgment. It is a state of mind where we are actively noticing new things.¹ When stated in this way, it becomes clear that an operating room may be considered a mindful room—one where intentions are set, and the moment experienced collectively in a nonjudgmental experience. Every surgeon had experienced mindfulness—when nothing else existed except that patient, that problem, and that surgical solution.

With guidance, practice, and repetitions, mindfulness can be utilized to cultivate focus, manage emotions, and reappraise situations for the better. The mindfulness focus is nonjudgmental awareness and soft openness to the present moment. By relating to the present moment, mindfulness trains us to accept the daily distress of life “as it is.” It removes any fixed, preconceived notion of a situation, action, or result. Therefore, mindfulness can be a valuable tool, as it dampens our emotional reaction to a rapidly evolving situation such as in the operating room or in the circumstance complications occur afterward.

When habitually reacting to any adverse situation, we lock our minds to a few predictable outcomes—anxiety, distress, and fear. This is because we let part of our midbrain, the amygdala, take control. The amygdala is part of the limbic system and regulates our behavior and emotional response.² It is a center for detecting threats and encoding emotional memories. In a typical nonstress environment, we have top-down control from the prefrontal cortex over our thoughts, actions, and emotions.

When we suffer from chronic stress, we lose that prefrontal cortex control, and the amygdala part of our midbrain takes control—a so-called “amygdala hijack.”³ The more we let our mind react to situations, the more influential the response of amygdala hijacks. As a result, chronic amygdala hijack can cause amygdala inertia—a persistent state of stress. This chronic locked state of mind can create emotional and physical suffering and poor decision-making in critical situations.⁴ Since the amygdala is a center for threat perception and emotional response, chronic activation leads to a vicious cycle, amplifying smaller adverse events.

Practicing mindfulness can bring structural changes in our brain through neuroplasticity.^5,6 Neuroplasticity is the brain’s ability to restructure or rewire. Compared to nonmeditators, meditators can differentially engage brain regions called the anterior cingulate cortex.⁷ The anterior cingulate cortex is essential for optimal decisions under stressful, rapidly changing conditions.

Given these benefits, mindfulness training is slowly being incorporated into medicine to reduce medical errors and burnout and improve surgical outcomes. For example, in a recently published randomized clinical trial of 21 first-year surgery residents, a modified mindfulness-based stress reduction class was associated with lower stress, better executive function scores, and faster motor skills than control participants.⁸

Meditation is just one of the ways to practice mindfulness. Many physicians and surgeons regularly practice mindful activities already—running, hiking, skiing, reading, gardening, and cooking are examples of activities that can have substantial mindfulness benefits. However, the benefits of mindfulness extend beyond our surgical experience and can have many benefits in our life, including work-life balance, efficiency, and general health. Just as many surgeons spend time working on their physical health in the gym, on the treadmill, or with Peloton, which has benefits in and out of the operating room, mindfulness practices are a way to improve one’s mental and emotional health that extends to multiple facets of our life.

Therefore, a structured curriculum for surgeons to develop mindfulness can have lasting benefits for well-being and sustainable surgical careers. By writing this article, we aim to introduce mindfulness training for urologists. There are many resources and literature available on how to practice mindfulness.⁹ We propose 2 simple habits that can be introduced into your daily routine to practice mindfulness.

The simplest method of cultivating mindfulness is:

1. Focusing on one’s breath: Observe each breath as it goes in through the nostrils and out through the nostrils. This practice, although it sounds simple, is challenging. One may notice that after a few breaths, one’s mind either drifts away to the future or dwells on the past. The key is to bring the awareness back to the breath nonjudgmentally. We discussed practicing this technique in a recent podcast.¹⁰

After a few months of practicing the breath work, one can slowly advance to other techniques such as body scan meditation, mindful movement, and loving-kindness meditation.

Body scan meditation involves focusing on one part of the body at a time, starting from the top of the head and working our way down to the toes. The goal is to bring awareness to each part of our body and any sensations we may feel. This practice dramatically benefits surgeons in understanding where their body is and how it feels during and after surgery.

Mindful movement involves focusing on our body and movement. It can be practiced through yoga, tai chi, or a mindful walk. It enhances mobility and flexibility, and can be partnered with cardiovascular exercise.

Loving-kindness meditation involves cultivating love, compassion, and kindness toward ourselves and others. Just 7-8 minutes of loving-kindness meditation can change the outlook of a day and may be particularly useful on the stressful clinic or operating room days.

2. Gratitude: Humans are programmed for negativity bias. That is a survival mechanism. However, the constant influx of negative thinking can create mental and physical health issues detrimental to our personal and professional growth. On the other hand, there are data, including functional MRI scans, showing how we can reduce chronic stress and prevent amygdala hijack by practicing gratitude. Being thankful helps us eliminate negative biases; therefore, it is a tool to override the default mode of our evolutionary behavior. Identifying at least 1 thing you are grateful for as part of a daily routine can cultivate gratitude, positivity, and happiness in the long term.