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Surgeon simulator 2 loading12/6/2023 These considerations suggest that performance based metrics alone may not suffice to reveal the trainees' actual state of readiness.Īlthough not as directly observable or well-defined as performance itself, cognitive load has nonetheless been operationalised in multiple ways. Or a trainee may reach a performance plateau where additional training does not improve overt patterns but continues to reduce the perceptual-motor and cognitive demands of the task 17. Focussed on completing a suture, a surgeon may miss a crucial alarm an instance of inattentional blindness/deafness 15, 16. If the primary technical task is difficult, for example, because the surgeon is continually mentally adjusting for mismatches between the endoscope and the instruments on the monitor 14, they will have fewer resources available to devote to anticipating the next steps or detecting a potential problem before it becomes an emergency. Some of these scenarios have been discussed in the context of LS 13. Under such circumstances a surgeon may be more easily distracted, entertain fewer alternatives, or persist with ineffective strategies 12. The exercise of non-technical skills may be impaired by excessive workload or stress. Rapidly making correct decisions and managing errors have been noted as critical components of surgical competence, which reduce the rates of patient mortality and complications 10, 11. Intraoperative decisions are required when, for example, a surgeon faces an anatomic anomaly or patient decompensation. In addition to technical skills based on visual and motor ability, surgeons generally use an array of non-technical skills that include mental readiness, cognitive flexibility, the ability to anticipate problems, team adaptation, safety awareness, situational awareness and communication style 9. These highlight further unmet needs in the context of training and assessment, which would be greatly helped by tools that can provide new insights into skill development 7, 8. The additional difficulties of performing LS relative to open surgery are widely acknowledged 6. They continuously translate hand movements into the inverted movements of tool-tips and receive limited haptic feedback. The share of laparoscopy procedures within the total number of appendectomy and cholecystectomies in the United Kingdom in 2017 were respectively 74% and 92%, up from 41 and 84% in 2010 5.ĭuring LS, surgeons coordinate their hands, eyes, and long-shaft instruments in trocars inserted at narrow incisions, while mentally translating two-dimensional real-time video into the three-dimensional intracorporal setting. In the United States in 2013, surgeons performed cholecystectomy laparoscopically in 96% of cases 4. Consequently, LS is becoming increasingly routine in many surgical conditions. Laparoscopic surgery (LS) offers substantial clinical and economic benefits over open surgery, including decreased postoperative pain and better utilisation of hospital beds and antibiotics 1, 2, 3. The physiological correlates studied in this paper, translated into technological products, could help develop standardised and more easily regulated frameworks for training and certification. We found that the multi-modal set of physiology features was a better predictor than any individual feature and artificial neural networks performed better than linear regression. Completion times were correlated with the physiologically predicted values with a correlation coefficient of 0.84. Reaction times to randomly timed auditory stimuli were correlated with the mean of the heart rate ( \(r = - 0.29\)) and heart rate variability ( \(r = 0.4\)). The subjective task difficulty, reaction time, and completion time were well predicted by the physiology features. We found significant correlations between the features and the traditional measures. These were compared with traditional behavioural and subjective measures in a dual-task setting. We measured data from 31 novices during laparoscopic exercises to extract features based on cardiac and ocular variables. As cognitive load decreases with increasing proficiency, its robust assessment through physiological data can help to develop more effective training and certification procedures in this area. Laparoscopic surgery can be exhausting and frustrating, and the cognitive load experienced by surgeons may have a major impact on patient safety as well as healthcare economics.
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