Simulation-Based Assessment of Electroencephalogram Focus Signals: Impact of Operative Strategy

Introduction: Electroencephalogram (EEG) measures the electrical activity of the brain and can be correlated with focus during activities. This study piloted the use of wearable EEG sensors during a simulated task to assess cognitive load during the procedure.

Methods: EEG data was collected during a partial simulated laparoscopic ventral hernia (LVH). Median focus score (0 to 100) was calculated during the mesh preparation and mesh placement phases (Figure 1). Mesh preparation was the period from when the participant picked up the piece of mesh to when it was placed in the abdomen including placement of anchoring sutures extracorporeally. Mesh placement was the period from when the mesh was placed into the abdomen to when the mesh was secured to the anterior abdominal wall.

Results: Six participants placed extracorporeal stay sutures during the mesh preparation phase (MPrepP) and four participants placed intracorporeal sutures during the mesh placement phase (MPlaceP). Compared to participants who used intracorporeal sutures, participants who placed extracorporeal sutures had significantly lower focus scores during the MplaceP (23.7 vs 38.0, p<0.01). There was no difference during the MPrepP (41.9 vs 33.8, p=0.56).

Conclusion: This study identified that placing stay sutures extracorporeally resulted in lower focus scores on EEG. The ability to detect a difference in cognitive load based on operative strategy supports the continued use of EEG to evaluate operative performance. Understanding how cognitive load changes throughout a procedure and by operative approach can help shape intra-operative instruction strategies to maximize learning.