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Impact Of Multi-tasking Under Dynamic Temporal Demand On Surgeons’ Brain Function
*Hemel N Modi, Ara Darzi, *Harsimrat Singh, *Daniel R Leff
Imperial College London, London, United Kingdom

OBJECTIVE(S): Neuroergonomics can provide valuable insights into the cognitive mechanisms of surgical performance. The prefrontal cortex (PFC) plays an important role in executive functioning, and its recruitment during times of escalating workload is critical for stabilizing motor performance. We investigated the impact of intraoperative time pressure and decision-making on PFC activation during a laparoscopic suturing task.
METHODS: In a randomized cross-over design, 29 surgical residents performed an intracorporeal suturing task with and without a secondary decision-making drill under self-paced and time pressure conditions. Activation in 2,784 prefrontal data channels was captured using optical neuroimaging. Subjective workload was quantified using SURG-TLX, and technical performance for all 580 knots was assessed using validated performance metrics.
RESULTS: Compared with self-paced suturing, subjective workload was significantly greater in time pressure suturing (146.0 vs. 196.0), suturing with decision-making (146.0 vs. 182.0), and time pressure suturing with decision-making (146.0 vs. 227.0). Technical performance during combined suturing and decision-making tasks was significantly inferior compared with time pressure and self-paced conditions (p<0.001). There was significant activation in the dorsolateral PFC (DLPFC) during self-paced suturing, and deactivation in the ventrolateral PFC (VLPFC) during time pressure suturing. However, suturing with decision-making resulted in substantial and significant deactivation in both the VLPFC and DLPFC (p<0.05). Random effects regression confirmed that decision-making predicts VLPFC and DLPFC deactivation (z=-2.62, p<0.05).
CONCLUSIONS: Surgical performance deterioration during high workload conditions is associated with deactivation of prefrontal regions important for attentional control, working memory and cognitive flexibility, particularly during tasks involving simultaneous motor and cognitive engagement.


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