Subjective and Objective Quantification of the Effect of Distraction on Physician’s Workload and Performance During Simulated Laparoscopic Surgery

Abstract

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.

The impact of distractions and interruptions in the operating room on patient safety and the operating room team: An integrative review

“…Observational studies use validated and reliable measuring tools to provide a thorough investigation of distractions and interruptions in ORs 1 . Simulation studies have the advantage of studying clinicians performing a primary task while adding a secondary task; this would be unethical and unsafe to conduct with real patients 2,19 . Virtual reality simulators are validated to measure surgical performance; however, generalisability of simulated studies to real ORs is limited 19 .…”

“…Operating rooms (ORs) are complex environments in which the whole OR team (surgical, anaesthetic and nursing personnel) experiences high levels of cognitive demand while maintaining concentration and performing often difficult and highly precise tasks [1][2][3] . In the OR, distractions and interruptions are ubiquitous and varied yet there remains a paucity of empirical literature on the specific effects they have on OR team members and patient safety 1,[4][5][6] .…”

“…Five simulation studies have been included in this review 2,4,10,19,22 , and one mixed-methods study by Sirihorachai et al 6 which combined observational and simulation components. There is also paucity in the simulation literature studying anaesthetists and nurses -no anaesthetic studies were found and Sirihorachai et al 6 was the sole nursing study.…”

“…The five surgeon studies all applied a distraction to novice subjects (medical students or surgical trainees) while they were performing a surgical technique or procedure on a simulator. Clinical decision-making and surgical performance were measured 2,4,10,19,22 .…”

“…Four studies applied an auditory and cognitive distraction including phones, pagers and patient complaints of pain 4,10,19,22 . However, Gao et al 2 used mental arithmetic. Sirihorachai et al 6 applied a variety of distractions to nurses.…”