Ücrak Fuat, Izzetoglu Kurtulus, Polat Mert Deniz, Gür Ümit, Şahin Turan, Yöner Serhat Ilgaz, İnan Neslihan Gökmen, Aksoy Mehmet Emin, Öztürk Cengizhan
The Institute of Biomedical Engineering, Boğaziçi University, Istanbul 34342, Turkey.
School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA.
Brain Sci. 2025 Apr 8;15(4):387. doi: 10.3390/brainsci15040387.
Minimally invasive surgical techniques, including laparoscopic and robotic surgery, have profoundly impacted surgical practice by improving precision, reducing recovery times, and minimizing complications. However, these modalities differ in their cognitive demands and skill acquisition requirements, which can influence the learning curve and operative performance. To assess and evaluate this variability across these modalities, a functional near-infrared spectroscopy (fNIRS) system is used as an objective method for monitoring cognitive activity in surgical trainees. fNIRS can provide insights and further our understanding of the mental demands of different surgical techniques and their association with varying task complexity.
This study seeks to assess the influence of surgical modality (laparoscopy vs. robotic surgery) and task complexity (pick and place (PP) vs. knot tying (KT)) on cognitive workload through fNIRS. We compare real-world and simulation-based training environments to determine changes in brain activation patterns and task performance.
A total of twenty-six surgical trainees (general and gynecologic surgery residents and specialists) participated in this study. Participants completed standardized laparoscopic and robotic surgical tasks at varying levels of complexity while their cognitive workload was measured using fNIRS. This study included both simulation-based training and real-world surgical environments. Hemodynamic responses in the prefrontal cortex (PFC), task completion times, and performance metrics were analyzed.
Laparoscopic surgery elicited higher activity changes in the prefrontal cortex, indicating increased cognitive demand compared with robotic surgery, particularly for complex tasks like knot tying. Task complexity significantly influenced mental load, with more intricate procedures eliciting greater neural activation. Real-world training resulted in higher cognitive engagement than simulation, emphasizing the gap between simulated and actual surgical performance.
Cognitive workload was lower and significantly different during robotic surgery than during laparoscopy, potentially due to its ergonomic advantages and enhanced motor control. Simulation-based training effectively prepares surgeons, but the cognitive workload results indicate that it may not fully replicate real-world surgical environments. These findings reveal the importance of cognitive workload assessment in surgical education and suggest that incorporating neuroimaging techniques such as fNIRS into training programs could enhance skill acquisition and performance.
包括腹腔镜手术和机器人手术在内的微创手术技术，通过提高精准度、缩短恢复时间以及减少并发症，对手术实践产生了深远影响。然而，这些手术方式在认知需求和技能获取要求方面存在差异，这可能会影响学习曲线和手术操作表现。为了评估和评价这些手术方式之间的这种差异，功能近红外光谱（fNIRS）系统被用作监测外科受训人员认知活动的一种客观方法。fNIRS能够提供见解，并加深我们对不同手术技术的心理需求及其与不同任务复杂性之间关联的理解。
本研究旨在通过fNIRS评估手术方式（腹腔镜手术与机器人手术）和任务复杂性（抓取与放置（PP）与打结（KT））对认知工作量的影响。我们比较真实世界和基于模拟的训练环境，以确定大脑激活模式和任务表现的变化。
共有26名外科受训人员（普通外科和妇科住院医师及专科医生）参与了本研究。参与者在不同复杂程度下完成标准化的腹腔镜和机器人手术任务，同时使用fNIRS测量他们的认知工作量。本研究包括基于模拟的训练和真实世界的手术环境。分析前额叶皮质（PFC）的血流动力学反应、任务完成时间和表现指标。
与机器人手术相比，腹腔镜手术在前额叶皮质引发了更高的活动变化，表明认知需求增加，尤其是对于像打结这样的复杂任务。任务复杂性显著影响心理负荷，更复杂的手术引发更大的神经激活。真实世界的训练比模拟训练导致更高的认知参与度，凸显了模拟手术与实际手术表现之间的差距。
机器人手术期间的认知工作量低于腹腔镜手术，且存在显著差异，这可能归因于其人体工程学优势和增强的运动控制。基于模拟的训练有效地培养了外科医生，但认知工作量结果表明它可能无法完全复制真实世界的手术环境。这些发现揭示了认知工作量评估在外科教育中的重要性，并表明将fNIRS等神经成像技术纳入培训计划可以提高技能获取和表现。
