Blood Flow Velocity of the Middle Cerebral Arteries: A Real-Time Measure of Attentional Load in the Laparoscopic Surgery Environment?

Laparoscope (camera) rotations in laparoscopic surgery, and the resulting perceptual-motor distortions, increases the workload (attentional load) of surgeons. When attentional load is high, risks of surgical errors and patient injury increase. Blood flow velocity (BFV) changes of the middle cerebral arteries (MCAs) may serve as a real-time measure of attentional load in this environment. Seventeen undergraduates performed a laparoscopic training task (peg-transfer task) in a laparoscopic simulator at a non-rotated camera angle (0° condition−camera directly in front of the participant) and a rotated condition (camera was rotated 135° to the side). Performance (transfer speed) was superior in the 0° condition and performance in both camera conditions improved over time. Further, BFV was greater at the 135° rotation and declined over time in both conditions. The decline in BFV co-occurred with improved peg-transfer performance that occurred in both camera conditions. The results suggest that BFV changes of the MCAs are a sensitive indicator of attentional load induced by the perceptual-motor distortions inherent in laparoscopy. Thus, it may be possible to use BFV changes of the MCAs, a non-invasive measure, to assess real-time attentional load and attentional resource utilization in the surgical environment