title: Inattention blindness in surgery.
abstract: BACKGROUND
  Inattention blindness (IB) can be defined as the failure to perceive an unexpected object when attention is focussed on another object or task. The principal aim of this study was to determine the effect of cognitive load and surgical image guidance on operative IB.
  
  
  METHODS
  Using a randomised control study design, participants were allocated to a high or low cognitive load group and subsequently to one of three augmented reality (AR) image guidance groups (no guidance, wireframe overlay and solid overlay). Randomised participants watched a segment of video from a robotic partial nephrectomy. Those in the high cognitive load groups were asked to keep a count of instrument movements, while those in the low cognitive load groups were only asked to watch the video. Two foreign bodies were visible within the operative scene: a swab, within the periphery of vision; and a suture, in the centre of the operative scene. Once the participants had finished watching the video, they were asked to report whether they had observed a swab or suture.
  
  
  RESULTS
  The overall level of prompted inattention blindness was 74 and 10 % for the swab and suture, respectively. Significantly higher levels of IB for the swab were seen in the high versus the low cognitive load groups, but not for the suture (8 vs. 47 %, p < 0.001 and 90 vs. 91 %, p = 1.000, for swab and suture, respectively). No significant difference was seen between image guidance groups for attention of the swab or suture (29 vs. 20 %, p = 0.520 and 22 vs. 22 %, p = 1.000, respectively).
  
  
  CONCLUSIONS
  The overall effect of IB on operative practice appeared to be significant, within the context of this study. When examining for the effects of AR image guidance and cognitive load on IB, only the latter was found to have significance.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, W2 1NY, UK. a.hughes-hallett@imperial.ac.uk.
authors.forename: Archie
authors.initials: A
authors.lastname: Hughes-Hallett
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, W2 1NY, UK. e.mayer@imperial.ac.uk.
authors.forename: Erik K
authors.initials: EK
authors.lastname: Mayer
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, W2 1NY, UK.|Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.
authors.forename: Hani J
authors.initials: HJ
authors.lastname: Marcus
authors.affiliation: Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Pratt
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, W2 1NY, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Mason
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, W2 1NY, UK.|Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.
authors.forename: Ara W
authors.initials: AW
authors.lastname: Darzi
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, W2 1NY, UK.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Vale
mesh_terms: D000328:Adult; D001288:Attention; D002055:Burnout, Professional / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D002983:Clinical Competence; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D066231:Surgeons / Q000523:psychology*; D013514:Surgical Procedures, Operative / Q000592:standards*; D014741:Video Recording; D016526:Workload / Q000523:psychology*
keywords: Augmented reality; Cognitive load; Inattention blindness; Laparoscopic; Safety; Surgery