The risk assessment of mental stress and early detection of mental illness among surgeons are much debated issues, because the perceived working conditions are important for their own health and that of the patients. Studies of predominantly mental stress are increasing and stay up-to-date. The psychological strain of surgeons is generally regarded as high. In order to objectively determine stress, the heart rate and its variability have been established as parameters. Based on the physiological stress parameter, it is possible to determine the previous level of strain. This work presents a summary of recent scientific studies to explore the stress in operative surgeons on the basis of the physiological stress parameters heart rate (HR) and heart rate variability (HRV). A PubMed search until spring of 2014 was performed. A total of 10 studies were included which deal with the mental stress and strain analysis by surgeons. In this case, 4 studies used only the HR and the further 6 studies used the HRV as a stress parameter. First stress and strain analyses of surgeons have been around since the early 1980s. The studies were usually carried out solely within the sample examined. Control groups have rarely or not been studied. In summary, stressed surgeons offered a higher intraoperative heart rate and a low expression of the HRV. The same was experienced in operating surgeons compared to the assistant surgeons or with inexperienced operating surgeons compared to experienced surgeons.