title: Impact of acute stress on psychomotor bimanual performance during a simulated tumor resection task.
abstract: OBJECTIVE Severe bleeding during neurosurgical operations can result in acute stress affecting the bimanual psychomotor performance of the operator, leading to surgical error and an adverse patient outcome. Objective methods to assess the influence of acute stress on neurosurgical bimanual psychomotor performance have not been developed. Virtual reality simulators, such as NeuroTouch, allow the testing of acute stress on psychomotor performance in risk-free environments. Thus, the purpose of this study was to explore the impact of a simulated stressful virtual reality tumor resection scenario by utilizing NeuroTouch to answer 2 questions: 1) What is the impact of acute stress on bimanual psychomotor performance during the resection of simulated tumors? 2) Does acute stress influence bimanual psychomotor performance immediately following the stressful episode? METHODS Study participants included 6 neurosurgeons, 6 senior and 6 junior neurosurgical residents, and 6 medical students. Participants resected a total of 6 simulated tumors, 1 of which (Tumor 4) involved uncontrollable "intraoperative" bleeding resulting in simulated cardiac arrest and thus providing the acute stress scenario. Tier 1 metrics included extent of blood loss, percentage of tumor resected, and "normal" brain tissue volume removed. Tier 2 metrics included simulated suction device (sucker) and ultrasonic aspirator total tip path length, as well as the sum and maximum forces applied in using these instruments. Advanced Tier 2 metrics included efficiency index, coordination index, ultrasonic aspirator path length index, and ultrasonic aspirator bimanual forces ratio. All metrics were assessed before, during, and after the stressful scenario. RESULTS The stress scenario caused expected significant increases in blood loss in all participant groups. Extent of tumor resected and brain volume removed decreased in the junior resident and medical student groups. Sucker total tip path length increased in the neurosurgeon group, whereas sucker forces increased in the senior resident group. Psychomotor performance on advanced Tier 2 metrics was altered during the stress scenario in all participant groups. Performance on all advanced Tier 2 metrics returned to pre-stress levels in the post-stress scenario tumor resections. CONCLUSIONS Results demonstrated that acute stress initiated by simulated severe intraoperative bleeding significantly decreases bimanual psychomotor performance during the acute stressful episode. The simulated intraoperative bleeding event had no significant influence on the advanced Tier 2 metrics monitored during the immediate post-stress operative performance.
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.|Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah.
authors.forename: Khalid
authors.initials: K
authors.lastname: Bajunaid
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec.
authors.forename: Muhammad Abu Shadeque
authors.initials: MA
authors.lastname: Mullah
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.
authors.forename: Alexander
authors.initials: A
authors.lastname: Winkler-Schwartz
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.|National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City.
authors.forename: Fahad E
authors.initials: FE
authors.lastname: Alotaibi
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.
authors.forename: Jawad
authors.initials: J
authors.lastname: Fares
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.
authors.forename: Marta
authors.initials: M
authors.lastname: Baggiani
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.|Department of Biomedical Engineering, Tehran Polytechnic, Tehran, Iran.
authors.forename: Hamed
authors.initials: H
authors.lastname: Azarnoush
authors.affiliation: University of Calgary, Faculty of Kinesiology, Calgary, Alberta, Canada.
authors.forename: Sommer
authors.initials: S
authors.lastname: Christie
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.|National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City.
authors.forename: Gmaan
authors.initials: G
authors.lastname: Al-Zhrani
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Marwa
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.|National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City.|Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; and.
authors.forename: Abdulrahman Jafar
authors.initials: AJ
authors.lastname: Sabbagh
authors.affiliation: University of Calgary, Faculty of Kinesiology, Calgary, Alberta, Canada.
authors.forename: Penny
authors.initials: P
authors.lastname: Werthner
authors.affiliation: Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital.
authors.forename: Rolando F
authors.initials: RF
authors.lastname: Del Maestro
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001932:Brain Neoplasms / Q000601:surgery*; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006225:Hand; D006801:Humans; D020300:Intracranial Hemorrhages / Q000628:therapy; D008297:Male; D000069471:Neurosurgeons / Q000523:psychology*; D019635:Neurosurgical Procedures; D011597:Psychomotor Performance; D013315:Stress, Psychological; D013337:Students, Medical; D000076142:Virtual Reality; D055815:Young Adult
keywords: NeuroTouch; PGY = postgraduate year; STAI = State-Trait Anxiety Inventory; acute stress; brain tumor; performance metrics; psychomotor performance; surgical technique; uncontrolled bleeding; virtual reality simulator