Effects of cognitive distraction on performance of laparoscopic surgical tasks

Hypothesis: To quantify the effects of cognitive distraction on surgical task performance in residents and medical students using a laparoscopic surgical simulator. Design: Within-subjects design. Setting: A surgical skills laboratory. Participants: Thirteen surgical residents and medical students who volunteered for the study. Methods and Materials: Subjects performed six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR), under two different conditions (distracted and undistracted). Task order remained the same for all subjects, but the order of distraction was counterbalanced. In the distracted condition, distractions consisted of mental arithmetic problems posed sequentially so that subjects were continually distracted. Main Outcome Measures: Time to task completion, surgical errors committed, economy of motion, and overall performance scores were generated by the MIST-VR program software. Arithmetic error was not a factor in the overall performance score. Results: Time to task completion was significantly greater when subjects were distracted for all six tasks performed. Overall score and economy of motion were negatively affected by distraction but the effect did not reach th level of statistical significance. There was no effect of distract on surgical errors. Conclusion: Cognitive distraction appears to negatively influence the performance of laparoscopic surgical tasks by increasing task completion time. Further study is required to determine what the effects would be on experienced surgeons and actual surgical outcomes.