Background Distracting interference cognitive tasks place undeniable pressure on the minds of people who need high precision and attention during the tasks, such as those tasks performed during surgery; these tasks might affect current surgical procedures. We measured the effect of additional cognitive tasks on the mental load of the physician by measuring the mean change in pupil size, blink rate, and subjective assessment during surgery. Material/Methods We recruited 24 participants with different levels of laparoscopic surgery to perform a complete appendectomy using a standardized virtual reality laparoscopic surgery simulator. The participants then performed the cognitive task (arithmetic problem), after that they performed an appendectomy surgery task while completing the cognitive task on the simulator. All participants wore trackers to monitor pupil size and blink rate during surgery and the cognitive task. The National Aeronautics and Space Administration (NASA) Task Load Index (TLX) score also recorded performance parameters during the surgical mission. Results The double-task pupil size and the blink rate were significantly increased compared to the single-task observation, and the associated increase in psychological load might have been affected by surgical performance, and the performance parameters were also statistically significant. However, for the aforementioned parameters, experienced surgeons had some differences compared with inexperienced surgeons, but these differences did not reach statistical significance. Conclusions Distracted cognitive task stimulation in the operating room can increase the surgeon’s psychological burden while also affecting their operational skills, thereby threatening patient safety; reduced cognitive costs might be obtained by improving or managing cognitive deficits.

Noise can exert undeniable pressure on human minds, especially during tasks that require high precision and attention, such as those performed during surgery. To investigate whether auditory stimuli increases mental loads during laparoscopic surgery, we examined the effects of operating room (OR) noises and music by measuring mean changes in pupil sizes and subjectively assessing performances during surgery. We recruited 24 subjects with varying laparoscopic surgery experience levels to perform complete appendectomy using a laparoscopic simulator. Wearable eye trackers were worn by all subjects to monitor pupil sizes during surgery, and surgical tasks were performed under conditions of silence, background OR noise, and music. National Aeronautics and Space Administration-Task Load Index scores and performance parameters were also recorded during surgical tasks. Noise distractions were associated with significant increases in pupil sizes compared with those observed in silence, and the related increases in mental loads may have affected surgical performance. However, more experienced operators had smaller changes in pupil sizes because of auditory disturbances than moderately experienced surgeons. Noise stimulation in the OR increases surgeon's mental workload and performance. Auditory regulation of the OR may be better standardized using data from studies of the effects of acoustic stimulation in the OR, and mental stresses during surgery could be considered in a more humane manner. Further investigations are necessary to determine the cognitive consequences of various auditory stimuli.

Although the mental workload confronted by laparoscopic surgeons is rather high, there is presently no reliable, established method for evaluating this workload. In the present study, four evaluation indices of eye movement metrics were applied to evaluate surgeons’ mental workload. Correlations between these indices and National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores were also explored. Sixteen participants were recruited to complete four laparoscopic procedures. Eye movement was recorded during the tasks, and NASA-TLX scales were also introduced for subjective evaluation. The data were analyzed using R 3.3.2. Significant differences in the mental workload of each task were observed. Statistically significant correlations between mean pupil diameter change and NASA-TLX scores were also observed. The correlation coefficients were 0.763, 0.675, 0.405, and 0.547, and the P values correspondingly were 0.001, 0.004, 0.12, and 0.028, respectively. The results clarify that the mental workload of laparoscopic surgeons is dependent on the specific demands of the operation. Appropriate objective physiological indices can be used to identify the mental workload state of the surgeon.