Journal
ANNALS OF BIOMEDICAL ENGINEERING
Volume 46, Issue 10, Pages 1621-1636Publisher
SPRINGER
DOI: 10.1007/s10439-018-2049-z
Keywords
Neuroimaging; Brain function; Stress; Cognitive workload; Surgical skills; Laparoscopy; Suturing
Categories
Funding
- Imperial NIHR BRC
- Imperial Cancer Research UK Centre
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Robotic surgery may improve technical performance and reduce mental demands compared to laparoscopic surgery. However, no studies have directly compared the impact of robotic and laparoscopic techniques on surgeons' brain function. This study aimed to assess the effect of the operative platform (robotic surgery or conventional laparoscopy) on prefrontal cortical activation during a suturing task performed under temporal demand. Eight surgeons (mean age +/- SD=34.5 +/- 2.9years, male:female ratio=7:1) performed an intracorporeal suturing task in a self-paced manner and under a 2min time restriction using conventional laparoscopic and robotic techniques. Prefrontal activation was assessed using near-infrared spectroscopy, subjective workload was captured using SURG-TLX questionnaires, and a continuous heart rate monitor measured systemic stress responses. Task progression scores (au), error scores (au), leak volumes (mL) and knot tensile strengths (N) provided objective assessment of technical performance. Under time pressure, robotic suturing led to improved technical performance (median task progression score: laparoscopic suturing=4.5 vs. robotic suturing=5.0; z=-2.107, p=0.035; median error score: laparoscopic suturing=3.0mm vs. robotic suturing=2.1mm; z=-2.488, p=0.013). Compared to laparoscopic suturing, greater prefrontal activation was identified in seven channels located primarily in lateral prefrontal regions. These results suggest that robotic surgery improves performance during high workload conditions and is associated with enhanced activation in regions of attention, concentration and task engagement.
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