title: Technical mentorship during robot-assisted surgery: a cognitive analysis.
abstract: To investigate cognitive and mental workload assessments, which may play a critical role in defining successful mentorship.
  
  
  
  The 'Mind Maps' project aimed at evaluating cognitive function with regard to surgeon's expertise and trainee's skills. The study included electroencephalogram (EEG) recordings of a mentor observing trainee surgeons in 20 procedures involving extended lymph node dissection (eLND) or urethrovesical anastomosis (UVA), with simultaneous assessment of trainees using the National Aeronautics and Space Administration Task Load index (NASA-TLX) questionnaire. We also compared the brain activity of the mentor during this study with his own brain activity while actually performing the same surgical steps from previous procedures populated in the 'Mind Maps' project.
  
  
  
  During eLND and UVA, when the mentor thought the trainee's mental demand and effort were low based on his NASA-TLX questionnaire (not satisfied with his performance), his EEG-based mental workload increased (reflecting more concern and attention). The mentor was mentally engaged and concerned while he was engrossed in observing the surgery. This was further supported by the finding that there was no significant difference in the mental demands and workload between observing and operating for the expert surgeon.
  
  
  
  This study objectively evaluated the cognitive engagement of a surgical mentor teaching technical skills during surgery. The study provides a deeper understanding of how surgical teaching actually works and opens new horizons for assessment and teaching of surgery. Further research is needed to study the feasibility of this novel concept in assessment and guidance of surgical performance.
authors: Applied Technology Laboratory for Advanced Surgery (ATLAS) Program, Roswell Park Cancer Institute, Buffalo, NY, USA.|Department of Urology, Cairo University, Cairo, Egypt.
authors: Ahmed A
authors: AA
authors: Hussein
authors: Human in the Loop System Laboratory, University at Buffalo, Buffalo, NY, USA.
authors: Somayeh B
authors: SB
authors: Shafiei
authors: Applied Technology Laboratory for Advanced Surgery (ATLAS) Program, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Mohamed
authors: M
authors: Sharif
authors: Human in the Loop System Laboratory, University at Buffalo, Buffalo, NY, USA.
authors: Ehsan
authors: E
authors: Esfahani
authors: Applied Technology Laboratory for Advanced Surgery (ATLAS) Program, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Basel
authors: B
authors: Ahmad
authors: Applied Technology Laboratory for Advanced Surgery (ATLAS) Program, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Justen D
authors: JD
authors: Kozlowski
authors: Applied Technology Laboratory for Advanced Surgery (ATLAS) Program, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Zishan
authors: Z
authors: Hashmi
authors: Applied Technology Laboratory for Advanced Surgery (ATLAS) Program, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Khurshid A
authors: KA
authors: Guru
mesh_terms: D000714:Anastomosis, Surgical; D002983:Clinical Competence; D003071:Cognition; D006801:Humans; D008197:Lymph Node Excision / Q000193:education / Q000379:methods; D008611:Mentors; D065287:Robotic Surgical Procedures / Q000193:education*; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000193:education* / Q000379:methods*; D016526:Workload
keywords: EEG; assessment; cognition; robot-assisted; surgery; training