Login to Access Video or Poster Abstract: MP51-05
Sources of Funding: Roswell Park Alliance Foundation.

Introduction

Stress increases mental workload leading to reduction in surgical performance and subsequently risking patient safety. Console surgeon and their teams often experience mental stress, yet there is little research about objective measurement of stress levels in the operating room during Robot-assisted Surgery (RAS). In the study, brain activity data are used to differentiate between causes of mental stress of mentor surgeon and the impact of trainee performance during RAS.

Methods

EEG data from surgical mentor while observing 87 Urethro-Vesical Anastomoses (UVA) and 74 Pelvic Lymph Node Dissections (PLND) performed by 3 trainees, as well as performing 26 UVA and 26 PLND is recorded. Level and type of mental stress were determined using the power spectral density, during different frequencies, of signals from 20 channel EEG. Performance scores were used to identify the relationship between performance and stress. Stress caused by worry about ability of safe completion were estimated by using the brain activity during upper alpha (11-12 Hz), sensorimotor rhythm (SMR, 12-15 Hz), and low beta (19-22 Hz) bands in the "Cz" channel (area in motor cortex). The activity at the upper beta and gamma was used to estimate stress level and anxiety and fear caused by risk prediction.

Results

Mentor's brain faces two main types of stresses during RAS. While observing low quality performance by trainee surgeons, the cause of mentor's mental stress is mostly worries about lack of proficiency of trainee surgeon (Type 1). However, stress of mentor while performing surgery or observing a high quality performance by trainee surgeon, is mostly the result of situation awareness and risk prediction on the operative field (Type 2). These two types of stress activate different areas of the brain in specific frequencies.

Conclusions

EEG can be used to separate different types of stress experienced during performing and mentoring robot-assisted surgery. A deeper understanding of the difference and effect of these stresses and their outcomes can lead to targeted intervention and quality improvement.

Funding

Roswell Park Alliance Foundation.