Neuroergonomic assessment of the robotic enhancement of surgery

Advances in surgery have led to marked improvements in patient care, in particular, indexed by minimally invasive surgery (MIS). With the assistance of technology, progressively more complex procedures are undertaken with the aim of diminishing the impact of surgery on the patient. However, this increases demands placed on the surgeon in terms of technical ability. Surgical robotics may overcome this by enhancing surgeon capability through a variety of means. However, it is imperative that novel equipment is scrutinised not only for its performance effects but as to its impact on the user. This is to ensure that not all a surgeon’s resources are devoted to using a new instrument rendering them unable to focus on other aspects of surgery such as dealing with unexpected events e.g. bleeding. Neuroergonomics encompasses the study of the brain and behaviour at work and entails appreciating the cortical correlates of work-related tasks in order to understand both task demands and how the work environment may be modulated to facilitate performance. This paradigm has been applied to safety critical industry such as aviation and air traffic control, and is wholly applicable to surgery especially as the increasing demands placed on surgeons may be more cognitive in nature and as such not be as readily detected with conventional ergonomic tools. This purpose of this thesis is to apply neuroergonomic principles to evaluate brain behaviour associated with complex surgical tasks and how this may be modulated by assistive technology. Using functional near infrared spectroscopy (fNIRS), the cortical substrate for undertaking a complicated navigational task, of the nature likely to benefit from robotic enhancement, is assessed. This establishes firstly, a reliance on cortical regions involved in visuospatial working memory; and secondly demonstrates that experts elicited greater cortical activity than novices. Subsequently, assistive technology known to enhance performance is assessed as to its impact on prefrontal cortical (PFC) activity. A randomised controlled trial across six sessions is then undertaken with the aim of appraising how this technology may affect the learning process in terms of frontoparietal cortical activity. Brain behaviour is assessed in terms of activity and network behaviour determined using graph theory. Finally, a novel tool for aiding collaborative surgery is investigated demonstrating a modulation of search strategy and underlying cortical activity affording subsequent performance improvement. This work sheds light on the neurocognitive aspects of undertaking surgical tasks and how this information can be applied within the paradigm of neuroergonomics to evaluate and assess novel instrumentation in surgery