Robotic Surgery Improves Technical Performance and Enhances Prefrontal Activation During High Temporal Demand

Figure 1. (a) The da Vinci® Si system (Intuitive Surgical Inc, Sunnyvale, CA) consists of a master console system with which the surgeon controls a slave unit comprising robotic arms that move around fixed pivot points and carry out the surgeon’s commands; (b) A bench-top box trainer (iSim2, iSurgicals, UK) used for the laparoscopic suturing task; (c) Key steps of the suturing task in which a reef knot is created: (i) mounting the needle onto the needle holder, (ii) inserting the needle into the Penrose drain as close to pre-marked target points as possible, (iii) exiting the needle out of the drain as close to pre-marked target points as possible, (iv) double throw of suture thread, (v) first single throw, and (vi) second single throw; (d) Prefrontal activation during the task was assessed using functional near-infrared spectroscopy (fNIRS), a non-invasive neuroimaging technique, which measures differences between emitted and detected near infrared light to estimate the local concentration changes of oxygenated haemoglobin (HbO2) and deoxygenated haemoglobin (HHb), as a surrogate of brain activation. The 3D head reconstruction demonstrates the 3 × 3 arrays of optodes located over the left…

Figure 2. (a) Subjective workload (SURG-TLX) scores, heart rate, and technical performance in self-paced (yellow bars) and time pressure (green bars) conditions during laparoscopic suturing. Error bars represent the 95% confidence interval; (b) Comparison of the HbO2 response (ΔHbO2) in time pressure and self-paced conditions during laparoscopic suturing. Channels exhibiting a smaller HbO2 response in the time pressure compared to the self-paced condition are blue, whereas those exhibiting a smaller response in the self-paced condition are red. Channels in which there was a significant difference (p < 0.05, Wilcoxon Signed Ranks test) in the HbO2 response between conditions are outlined (black circle). Reference points of the 10–20 system of optode placement are shown in yellow (right PFC: Fp2 = source 6, F8 = source 7, F2 = source 9, FC4 = source 10; left PFC: Fp1 = source 2, F7 = source 1, F1 = source 5, FC3 = source 4). Au arbitrary units, ΔHR change in heart rate from rest to task, bpm beats per minute, mm millimetres, mL millilitres, N Newtons.

Figure 3. (a) Subjective workload (SURG-TLX) scores, heart rate, and technical performance in self-paced (yellow bars) and time pressure (green bars) conditions during robotic suturing. Error bars represent the 95% confidence interval; (b) Comparison of the HbO2 response (ΔHbO2) in time pressure and self-paced conditions during robotic suturing. Channels exhibiting a smaller HbO2 response in the time pressure compared to the self-paced condition are blue, whereas those exhibiting a smaller response in the self-paced condition are red. Channels in which there was a significant difference (p < 0.05, Wilcoxon Signed Ranks test) in the HbO2 response between conditions are outlined (black circle). Reference points of the 10–20 system of optode placement are shown in yellow (right PFC: Fp2 = source 6, F8 = source 7, F2 = source 9, FC4 = source 10; left PFC: Fp1 = source 2, F7 = source 1, F1 = source 5, FC3 = source 4). Au arbitrary units, ΔHR change in heart rate from rest to task, bpm beats per minute, mm millimetres, mL millilitres, N Newtons.

Figure 4. (a) Subjective workload (SURG-TLX) scores, heart rate, and technical performance in laparoscopic (yellow bars) and robotic (green bars) suturing in the self-paced condition. Error bars represent the 95% confidence interval; (b) Comparison of the HbO2 response (ΔHbO2) during laparoscopic and robotic suturing in the self-paced condition. Channels exhibiting a smaller HbO2 response during robotic suturing compared to laparoscopic suturing are blue, whereas those exhibiting a smaller response during laparoscopic suturing are red. Channels in which there was a significant difference (p < 0.05, Wilcoxon Signed Ranks test) in the HbO2 response between operative platforms are outlined (black circle). Reference points of the 10–20 system of optode placement are shown in yellow (right PFC: Fp2 = source 6, F8 = source 7, F2 = source 9, FC4 = source 10; left PFC: Fp1 = source 2, F7 = source 1, F1 = source 5, FC3 = source 4). Au arbitrary units, ΔHR change in heart rate from rest to task, bpm beats per minute, mm millimetres, mL millilitres, N Newtons.

Figure 5. (a) Subjective workload (SURG-TLX) scores, heart rate, and technical performance in laparoscopic (yellow bars) and robotic (green bars) suturing in the time pressure condition. Error bars represent the 95% confidence interval; (b) Comparison of the HbO2 response (ΔHbO2) during laparoscopic and robotic suturing in the time pressure condition. Channels exhibiting a smaller HbO2 response during robotic suturing compared to laparoscopic suturing are blue, whereas those exhibiting a smaller response during laparoscopic suturing are red. Channels in which there was a significant difference (p < 0.05, Wilcoxon Signed Ranks test) in the HbO2 response between operative platforms are outlined (black circle). Reference points of the 10–20 system of optode placement are shown in yellow (right PFC: Fp2 = source 6, F8 = source 7, F2 = source 9, FC4 = source 10; left PFC: Fp1 = source 2, F7 = source 1, F1 = source 5, FC3 = source 4). Au arbitrary units, ΔHR change in heart rate from rest to task, bpm beats per minute, mm millimetres, mL millilitres, N Newtons.