“Losing Your Nerve in the Operating Room” – Prefrontal Attenuation is Associated with Performance Degradation under Temporal Demands

MATERIALS & METHODS 33 general surgery trainees (ST3-Post-CCT fellow) were asked to perform a laparoscopic suturing task under (1) ‘self-paced’ conditions, in which subjects were permitted to take as long as require to tie each knot, and (2) ‘time pressure’ conditions, in which a time limit of 2 minutes per knot was imposed. Participants were required to tie 5 interrupted knots in each condition, with an inter-trial rest period of 30 seconds. Subjective workload was measured using the validated Surgical Task Load Index (SURGTLX) questionnaire. Prefrontal activation responses were inferred from changes in cortical haemoglobin species, measured using a 24-channel functional near-infrared spectroscopy system (ETG-4000, Hitachi Medical Corp., Japan). Technical performance was assess using task progression scores (au), error scores (mm), leak volumes (ml), and knot tensile strengths (N).