Enhancing Surgeons' Cognitive Performance in Colorectal Surgery: A Narrative Review

Area of Science:

• Surgical Cognition and Artificial Intelligence
• Digital Health in Surgery

Background:

• Colorectal surgery outcomes vary despite advanced techniques, often due to unstructured, experience-based decision-making.
• This variability is linked to cognitive processes rather than solely technical skill.

Purpose of the Study:

• To examine the cognitive factors influencing surgical strategy in colorectal surgery.
• To evaluate how artificial intelligence (AI)-enabled decision support can improve consistency, reproducibility, and equity in colorectal care.

Main Methods:

• A hybrid narrative review synthesizing literature on surgical cognition, naturalistic decision-making, and augmented intelligence.
• Integration of perspectives from behavioral science, digital health, and colorectal surgery.
• AI-assisted dialogue (ChatGPT-4o) used for hypothesis generation and linguistic refinement, with human oversight for accuracy.

Main Results:

• Experience-based decision-making is prone to bias and variability in complex cases.
• Cognitive augmentation tools show potential for improving decision reliability but face challenges in implementation (data issues, standardization, adoption).
• Robotic surgery enhances technical execution but requires integration with cognitive tools for strategic reasoning.

Conclusions:

• Achieving strategic consistency in colorectal surgery necessitates a move towards cognitively structured decision-making.
• Intelligent, context-aware support systems augmenting surgeon judgment are crucial for reproducible, high-quality surgical care.