Robotic Surgery Improves Technical Performance and Enhances Prefrontal Activation During High Temporal Demand.

Area of Science:

• Neurosurgery
• Surgical Technology
• Cognitive Neuroscience

Background:

• Robotic surgery may offer advantages over laparoscopic surgery in technical skill and cognitive load.
• Direct comparisons of the neurological impact of robotic versus laparoscopic techniques are lacking.

Purpose of the Study:

• To evaluate the effect of the surgical platform (robotic vs. laparoscopic) on prefrontal cortical activation during a suturing task under time constraints.
• To compare the technical performance and physiological stress responses between robotic and laparoscopic suturing.

Main Methods:

• Eight surgeons performed intracorporeal suturing under self-paced and time-restricted conditions using both laparoscopic and robotic systems.
• Near-infrared spectroscopy (NIRS) measured prefrontal activation, while SURG-TLX questionnaires assessed workload and heart rate monitors tracked stress.
• Technical performance was objectively measured by task progression, errors, leak volume, and knot tensile strength.

Main Results:

• Under time pressure, robotic suturing demonstrated significantly improved task progression (p=0.035) and reduced errors (p=0.013) compared to laparoscopic suturing.
• Robotic surgery was associated with greater prefrontal cortical activation in lateral regions, suggesting enhanced cognitive engagement.
• No significant differences were noted in subjective workload or systemic stress responses between the two techniques.

Conclusions:

• Robotic surgery improves surgical performance and cognitive function, particularly under high workload conditions.
• The enhanced prefrontal activation during robotic surgery suggests improved attention, concentration, and task engagement.
• These findings support the adoption of robotic platforms for complex surgical tasks requiring precision and cognitive control.