Intra-operative disruptions, surgeon's mental workload, and technical performance in a full-scale simulated procedure.

BACKGROUND AND AIM: Surgical flow disruptions occur frequently and jeopardize perioperative care and surgical performance. So far, insights into subjective and cognitive implications of intra-operative disruptions for surgeons and inherent consequences for performance are inconsistent. This study aimed to investigate the effect of surgical flow disruption on surgeon's intra-operative workload and technical performance. METHODS: In a full-scale OR simulation, 19 surgeons were randomly allocated to either of the two disruption scenarios (telephone call vs. patient discomfort). Using a mixed virtual reality simulator with a computerized, high-fidelity mannequin, all surgeons were trained in performing a vertebroplasty procedure and subsequently performed such a procedure under experimental conditions. Standardized measures on subjective workload and technical performance (trocar positioning deviation from expert-defined standard, number, and duration of X-ray acquisitions) were collected. RESULTS: Intra-operative workload during simulated disruption scenarios was significantly higher compared to training sessions (p < .01). Surgeons in the telephone call scenario experienced significantly more distraction compared to their colleagues in the patient discomfort scenario (p < .05). However, workload tended to be increased in surgeons who coped with distractions due to patient discomfort. Technical performance was not significantly different between both disruption scenarios. We found a significant association between surgeons' intra-operative workload and technical performance such that surgeons with increased mental workload tended to perform worse (ß = .55, p = .04). CONCLUSIONS: Surgical flow disruptions affect surgeons' intra-operative workload. Increased mental workload was associated with inferior technical performance. Our simulation-based findings emphasize the need to establish smooth surgical flow which is characterized by a low level of process deviations and disruptions.

Vertebroplasty Performance on Simulator for 19 Surgeons Using Hierarchical Task Analysis.

We present a unique simulator-based methodology for assessing both technical and nontechnical (cognitive) skills for surgical trainees while immersed in a complete medical simulation environment. Further, we have included two crisis scenarios which allow for the evaluation of the effect of cognitive strategy selection on the low-level surgical skills. Training these mixed-mode scenarios can thereby be evaluated on our platform, allowing for improved assessment and a stronger foundation for credentialing, with the potential to reduce the occurrence of adverse events in the operating room. Scientific evaluation and validation of our work is conducted together with 19 junior surgeons in order to achieve the following goals: 1) to provide a qualitative measure of usability, 2) to assess vertebroplasty technical performance of the surgeon, and 3) to explore the relationship between mental workload and surgical performance during crisis. Our results indicate that: 1) the surgeons scored the face validity of our modeled simulation environment very highly ( 4.68 ±0.48, using a 5-point Likert scale), 2) surgeon training enabled completion of tasks more quickly, and 3) the introduction of crisis scenarios negatively affected the surgeons' objective performance. Taken together, our results underscore the need to develop realistic simulation environments that prepare young residents to respond to emergent events in the operating room.

Training for planning tumour resection: augmented reality and human factors.

Planning surgical interventions is a complex task, demanding a high degree of perceptual, cognitive, and sensorimotor skills to reduce intra- and post-operative complications. This process requires spatial reasoning to coordinate between the preoperatively acquired medical images and patient reference frames. In the case of neurosurgical interventions, traditional approaches to planning tend to focus on providing a means for visualizing medical images, but rarely support transformation between different spatial reference frames. Thus, surgeons often rely on their previous experience and intuition as their sole guide is to perform mental transformation. In case of junior residents, this may lead to longer operation times or increased chance of error under additional cognitive demands. In this paper, we introduce a mixed augmented-/virtual-reality system to facilitate training for planning a common neurosurgical procedure, brain tumour resection. The proposed system is designed and evaluated with human factors explicitly in mind, alleviating the difficulty of mental transformation. Our results indicate that, compared to conventional planning environments, the proposed system greatly improves the nonclinicians' performance, independent of the sensorimotor tasks performed ( ). Furthermore, the use of the proposed system by clinicians resulted in a significant reduction in time to perform clinically relevant tasks ( ). These results demonstrate the role of mixed-reality systems in assisting residents to develop necessary spatial reasoning skills needed for planning brain tumour resection, improving patient outcomes.

A novel integrative method for analyzing eye and hand behaviour during reaching and grasping in an MRI environment.

The development of noninvasive neuroimaging techniques, such as fMRI, has rapidly advanced our understanding of the neural systems underlying the integration of visual and motor information. However, the fMRI experimental design is restricted by several environmental elements, such as the presence of the magnetic field and the restricted view of the participant, making it difficult to monitor and measure behaviour. The present article describes a novel, specialized software package developed in our laboratory called Biometric Integration Recording and Analysis (BIRA). BIRA integrates video with kinematic data derived from the hand and eye, acquired using MRI-compatible equipment. The present article demonstrates the acquisition and analysis of eye and hand data using BIRA in a mock (0 Tesla) scanner. A method for collecting and integrating gaze and kinematic data in fMRI studies on visuomotor behaviour has several advantages: Specifically, it will allow for more sophisticated, behaviourally driven analyses and eliminate potential confounds of gaze or kinematic data.

Evaluation of a VR and stereo-endoscopic tool to facilitate 3rd ventriculostomy.

Endoscopic third ventriculostomy is a minimally invasive technique to treat hydrocephalus, which is a condition in which the patient is retaining excessive amount of cerebrospinal fluid in the head. While this surgical procedure is fairly routine, it carries some risks, mainly associated with the lack of depth perception, since monocular endoscopes provide only 2D views. We studied the advantages given by a 3D stereoendoscope over a 2D monocular endoscope, first by assessing the variability of stereoacuity in each subject, then in analyzing their overall correct response rate in differentiating between heights of two different images with 2D and 3D vision.

A comparison between a matrix-based and a region-based P300 speller paradigms for brain-computer interface.

A brain-computer interface (BCI) is a system that conveys messages and commands directly from the human brain to a computer. The BCI system described in this work is based on P300 wave. The P300 is a positive peak of an event-related potential (ERP) that happens 300 ms after a stimulus. One of the most well-known and widely-used P300 applications is P300 speller designed by Farwell-Donchin in 1988. The Farwell-Donchin paradigm has been a benchmark in P300 BCI. In this paradigm, a 6x6 matrix of letters and numbers is displayed and subject focuses on a target character while rows and columns of characters flash. By detecting P300 for one row and one column, the target character can be identified. In this paper, it is shown that there is a human perceptual error in Farwell-Donchin paradigm. To remove this error, a new region-based paradigm is presented. Using experimental results, it is shown that the new paradigm has several advantages and it achieves a better accuracy compared to the Farwell-Donchin paradigm.