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Multitasking and time pressure in the operating room: impact on surgeons’ brain function

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Title: Multitasking and time pressure in the operating room: impact on surgeons’ brain function
Authors: Modi, H
Singh, H
Darzi, A
Leff, D
Item Type: Journal Article
Abstract: Objective:To assess the impact of multitasking and time pressure on surgeons’ brain function during laparoscopic suturing.Summary Background Data:Recent neuroimaging evidencesuggests that deterioration in surgical performance under time pressure is associated with deactivationof the prefrontal cortex (PFC),an area important for executive functions. However, the effect ofmultitasking on operator brain functionremains unknown.Methods:29surgical residentsperformed anintracorporealsuturing task under fourconditions: 1) self-pacedsuturing,2) time-pressured suturing, 3) self-paced suturingplus decision-making, and 4) time-pressured suturing plus decision-making. Subjectiveworkload was quantified using the Surgical Task Load Index. Technical skill was objectively assessed using task progression scores, error scores, leak volumes, and knot tensile strengths. PFC activation was measuredusing optical neuroimaging. Results:Compared with self-paced suturing, subjective workload(au)was significantly greater in time-pressuredsuturing (146.0 vs. 196.0), suturing with decision-making (146.0 vs.182.0), and time-pressuredsuturing with decision-making (146.0 vs.227.0). Technical performance duringcombined suturing and decision-making taskswas inferiortosuturing alone undertime pressure orself-paced conditions(p<0.001).Significant dorsolateral PFC (DLPFC) activations were observed during self-paced suturing, and ventrolateral PFC (VLPFC) deactivations were identified during time-pressuredsuturing. However, suturing in conjunction withdecision-making resulted in 2significantdeactivation across boththe VLPFC and DLPFC (p<0.05). Random effects regression analysis confirmed decision-making predicts VLPFC and DLPFC deactivation (z=-2.62, p<0.05).Conclusions:Performance degradation 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 andcognitive engagement.
Issue Date: 1-Oct-2020
Date of Acceptance: 16-May-2020
URI: http://hdl.handle.net/10044/1/80519
DOI: 10.1097/SLA.0000000000004208
ISSN: 0003-4932
Publisher: Lippincott, Williams & Wilkins
Start Page: 648
End Page: 657
Journal / Book Title: Annals of Surgery
Volume: 272
Issue: 4
Copyright Statement: © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Sponsor/Funder: National Institute of Health Research
Keywords: Surgery
11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2020-07-09
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
Institute of Global Health Innovation