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The Impact of Minimally Invasive Surgical Modality and Task Complexity on Cognitive Workload: An fNIRS Study.

Fuat Ücrak1, Kurtulus Izzetoglu2, Mert Deniz Polat2

  • 1The Institute of Biomedical Engineering, Boğaziçi University, Istanbul 34342, Turkey.

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Summary

Robotic surgery requires less cognitive workload than laparoscopy, especially for complex tasks. Simulation training is valuable but doesn't fully replicate real-world cognitive demands, highlighting the need for neuroimaging in surgical education.

Keywords:
cognitive workloadfunctional near-infrared spectroscopy (fNIRS)laparoscopic surgeryminimally invasive surgeryrobotic surgerysurgical training

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Area of Science:

  • Neuroscience
  • Surgical Education
  • Minimally Invasive Surgery

Background:

  • Minimally invasive surgery (laparoscopic and robotic) offers benefits but differs in cognitive demands.
  • Functional near-infrared spectroscopy (fNIRS) objectively monitors cognitive activity in surgical trainees.
  • Understanding mental demands is crucial for optimizing surgical training and performance.

Purpose of the Study:

  • To assess the influence of surgical modality (laparoscopy vs. robotic) and task complexity on cognitive workload using fNIRS.
  • To compare cognitive workload in real-world versus simulation-based training environments.
  • To correlate brain activation patterns with task performance in surgical trainees.

Main Methods:

  • Twenty-six surgical trainees performed standardized laparoscopic and robotic tasks of varying complexity.
  • Cognitive workload was measured using fNIRS, monitoring hemodynamic responses in the prefrontal cortex (PFC).
  • Task completion times and performance metrics were analyzed alongside fNIRS data.

Main Results:

  • Laparoscopic surgery showed higher prefrontal cortex activity than robotic surgery, indicating greater cognitive demand, especially for knot tying.
  • Increased task complexity significantly elevated mental load and neural activation.
  • Real-world surgical training induced higher cognitive engagement compared to simulation-based training.

Conclusions:

  • Robotic surgery demonstrated a significantly lower cognitive workload than laparoscopy, attributed to ergonomic advantages and enhanced motor control.
  • Simulation-based training effectively prepares surgeons but may not fully replicate the cognitive demands of real-world surgery.
  • Integrating neuroimaging techniques like fNIRS into surgical education can enhance skill acquisition and performance assessment.