Huotarinen Antti, Niemelä Mika, Hafez Ahmad
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
Surg Neurol Int. 2018 Apr 5;9:71. doi: 10.4103/sni.sni_427_17. eCollection 2018.
Neurosurgeons are exposed to unavoidable distractions in their natural operating environment. Distractions can affect both the surgeon's concentration and the safety and duration of the surgery. Such distraction can be studied by applying a simultaneous cognitive task during a surgical procedure.
We used a previously described cognitive task: a forward (DF) and backward digit (DB) repetition task to interfere with the surgeon's attention during a training bypass. A pilot study was performed to find suitable digit repetition lengths. For the main experiment, we used four-digit strings. The test task was alternated across two consecutive sutures ( = 153, 8 bypasses), followed by two consecutive control sutures without digit repetition. The duration and the number of correct answers for the digit repetition task were compared to a baseline digit repetition without simultaneous surgery.
During the bypass surgery, digit repetitions (especially DB) became slower ( < 0.0001). More errors were made during DB compared to DF only during simultaneous bypass ( < 0.0001). However, we found no effect of digit repetition tasks on individual suture times ( = 0.823).
The ability to engage in simultaneous tasks while performing surgery is diminished. A surgeon with extensive training can withstand external distraction without an effect on performance; however, this is achieved by partially ignoring the simultaneous task. Our data support that during surgery other cognitive tasks should be avoided to ensure safety.
神经外科医生在其自然手术环境中会面临不可避免的干扰。干扰会影响外科医生的注意力以及手术的安全性和时长。可以通过在手术过程中应用同步认知任务来研究此类干扰。
我们使用了先前描述的认知任务：顺背（DF）和倒背（DB）数字重复任务，以在训练搭桥手术期间干扰外科医生的注意力。进行了一项试点研究以确定合适的数字重复长度。对于主要实验，我们使用了四位数字串。测试任务在连续的两针缝合（= 153，8次搭桥）中交替进行，随后是连续两针不进行数字重复的对照缝合。将数字重复任务的时长和正确答案数量与无同步手术时的基线数字重复进行比较。
在搭桥手术期间，数字重复（尤其是DB）变慢（<0.0001）。仅在同步搭桥期间，与DF相比，DB时出现的错误更多（<0.0001）。然而，我们发现数字重复任务对单个缝合时间没有影响（= 0.823）。
手术时进行同步任务的能力会下降。经过广泛训练的外科医生可以承受外部干扰而不影响手术表现；然而，这是通过部分忽略同步任务来实现的。我们的数据支持在手术期间应避免其他认知任务以确保安全。
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