The impact of minimally invasive surgical modality and task complexity on cognitive workload: an fNIRS study

Abstract

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.