title: Evaluating Robotic Surgical Skills Performance Under Distractive Environment Using Objective and Subjective Measures.
abstract: BACKGROUND
  Distractions are recognized as a significant factor affecting performance in safety critical domains. Although operating rooms are generally full of distractions, the effect of distractions on robot-assisted surgical (RAS) performance is unclear. Our aim was to investigate the effect of distractions on RAS performance using both objective and subjective measures.
  
  
  METHODS
  Fifteen participants performed a knot-tying task using the da Vinci Surgical System and were exposed to 3 distractions: (1) passive distraction entailed listening to noise with a constant heart rate, (2) active distraction included listening to noise and acknowledging a change of random heart rate from 60 to 120 bpm, and (3) interactive distraction consisted of answering math questions. The objective kinematics of the surgical instrument tips were used to evaluate performance. Electromyography (EMG) of the forearm and hand muscles of the participants were collected. The median EMG frequency (EMG(fmed)) and the EMG envelope (EMG(env)) were analyzed. NASA Task Load Index and Fundamentals of Laparoscopic Surgery score were used to evaluate the subjective performance. One-way repeated analysis of variance was applied to examine the effects of distraction on skills performance. Spearman's correlations were conducted to compare objective and subjective measures.
  
  
  RESULTS
  Significant distraction effect was found for all objective kinematics measures (P < .05). There were significant distraction effects for EMG measures (EMG(env), P < .004; EMG(fmed), P = .031). Significant distraction effects were also found for subjective measurements.
  
  
  CONCLUSIONS
  Distraction impairs surgical skills performance and increases muscle work. Understanding how the surgeons cope with distractions is important in developing surgical education.
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Irene H
authors.initials: IH
authors.lastname: Suh
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: LaGrange
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA University of Nebraska at Omaha, Omaha, NE, USA kcsiu@unmc.edu.
authors.forename: Ka-Chun
authors.initials: KC
authors.lastname: Siu
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D001696:Biomechanical Phenomena; D002983:Clinical Competence; D004576:Electromyography; D005260:Female; D005542:Forearm / Q000502:physiology; D006225:Hand / Q000502:physiology; D006801:Humans; D008297:Male; D009622:Noise; D065287:Robotic Surgical Procedures; D013647:Task Performance and Analysis; D055815:Young Adult
keywords: NASA Task Load Index; da Vinci Surgical System; electromyography; kinematics; noise