title: Understanding Cognitive Performance During Robot-Assisted Surgery.
abstract: OBJECTIVE
  To understand cognitive function of an expert surgeon in various surgical scenarios while performing robot-assisted surgery.
  
  
  METHODS
  In an Internal Review Board approved study, National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire with surgical field notes were simultaneously completed. A wireless electroencephalography (EEG) headset was used to monitor brain activity during all procedures. Three key portions were evaluated: lysis of adhesions, extended lymph node dissection, and urethro-vesical anastomosis (UVA). Cognitive metrics extracted were distraction, mental workload, and mental state.
  
  
  RESULTS
  In evaluating lysis of adhesions, mental state (EEG) was associated with better performance (NASA-TLX). Utilizing more mental resources resulted in better performance as self-reported. Outcomes of lysis were highly dependent on cognitive function and decision-making skills. In evaluating extended lymph node dissection, there was a negative correlation between distraction level (EEG) and mental demand, physical demand and effort (NASA-TLX). Similar to lysis of adhesion, utilizing more mental resources resulted in better performance (NASA-TLX). Lastly, with UVA, workload (EEG) negatively correlated with mental and temporal demand and was associated with better performance (NASA-TLX). The EEG recorded workload as seen here was a combination of both cognitive performance (finding solution) and motor workload (execution). Majority of workload was contributed by motor workload of an expert surgeon. During UVA, muscle memory and motor skills of expert are keys to completing the UVA.
  
  
  CONCLUSIONS
  Cognitive analysis shows that expert surgeons utilized different mental resources based on their need.
authors.affiliation: Department of Urology, Applied Technology Laboratory for Advanced Surgery (ATLAS) Program at Roswell Park Cancer Institute, Buffalo, NY. Electronic address: Khurshid.guru@roswellpark.org.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
authors.affiliation: Department of Mechanical and Aerospace Engineering, Human in the Loop System Laboratory, University at Buffalo, Buffalo, NY.
authors.forename: Somayeh B
authors.initials: SB
authors.lastname: Shafiei
authors.affiliation: Department of Urology, Applied Technology Laboratory for Advanced Surgery (ATLAS) Program at Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Atif
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Urology, Applied Technology Laboratory for Advanced Surgery (ATLAS) Program at Roswell Park Cancer Institute, Buffalo, NY; Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Department of Urology, Applied Technology Laboratory for Advanced Surgery (ATLAS) Program at Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sharif
authors.affiliation: Department of Mechanical and Aerospace Engineering, Human in the Loop System Laboratory, University at Buffalo, Buffalo, NY.
authors.forename: Ehsan T
authors.initials: ET
authors.lastname: Esfahani
mesh_terms: D003071:Cognition / Q000502:physiology*; D032882:Comprehension; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D012371:Robotics; D013514:Surgical Procedures, Operative / Q000523:psychology*; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D014481:United States; D016526:Workload / Q000523:psychology*