This is a critical situation for a surgeon, as they must perform emergency surgery on a 65-year-old man with a high body mass index and a heart issue due to a perforated appendix.

A situation of internal bleeding has been identified, there is a malfunction with the monitoring device for anesthesia, and there are multiple alert noises being emitted – followed by an urgent notification about an ectopic pregnancy on a different ward.

This kind of drama routinely plays out in operating theatres, but in this case trainee surgeon Mary Goble is being put through her paces by a team of researchers at Imperial College London who are studying what goes on inside the brains of surgeons as they perform life-or-death procedures.

Goble appears calm and composed while performing laparoscopic removal of the silicon appendix, despite facing various distractions. However, her brain’s activity, which is being monitored through a cap with optical probes, may show a contrasting narrative.

According to a team of researchers led by Daniel Leff, a senior researcher and breast surgeon at Imperial College healthcare NHS Trust, efforts are being made to identify indications of cognitive overload by analyzing brain activity. They believe that this could potentially be used to identify warning signals during surgical procedures.

Leff stated that performing surgeries in the operating room can be a chaotic experience, requiring surgeons to remain composed and level-headed even when faced with chaos. This is particularly important for ensuring patient safety, as the increased cognitive load in this environment can have significant impacts. Unfortunately, there is currently no way to measure a surgeon’s ability to handle the demands of this environment. The question then becomes, what happens when a surgeon reaches their maximum level of cognitive capacity?

Leff’s vision for the future involves a system that can monitor brain activity in real-time during surgeries and prompt an intervention if a surgeon is experiencing excessive strain.

Leff described the potential use of automatically playing soothing music for those who have a preference for Whitney Houston’s music. Alternatively, it could notify the lead theatre nurse to handle any unforeseen disturbances in the operating room. Leff likened it to the concept of “Minority Report” in surgical settings.

Alternatively, there is potential for utilizing brain stimulation to enhance a surgeon’s abilities when facing a loss of focus.

Goble’s cap utilizes fNIRS, a noninvasive method for detecting changes in brain oxygen levels, to assess neural activity. Previous studies have indicated that novice surgeons have higher pre-frontal brain activity compared to seasoned doctors during surgery. Additionally, pre-frontal activity seems to be more susceptible to disruption in doctors who experience a decline in performance during stressful scenarios.

Recent research is focused on identifying the fNIRS patterns associated with cognitive overload, which occurs when a doctor’s performance declines due to an overwhelming amount of information and tasks. This study will use trainee surgeons to monitor brain activity and surgical performance as they are faced with increasing demands. The controlled environment allows for precise tracking of laparoscopic instrument movements, while copper wires in the silicon appendix can detect if incisions are made accurately.

According to Leff, it is common for people, specifically doctors, to hide their internal struggles and adopt a mindset of perseverance.

Following the practice session, Dr. Goble, a surgical trainee at Kings College NHS Trust and participant in the study, expressed that her stress levels had significantly increased, despite it being a simulation. She stated, “The surgical setting can be quite stressful. During a night shift, when you’re working alone and managing competing clinical demands, it’s easy to become overwhelmed. To cope, I focus on my breathing as a form of concentration.”

According to Leff, simulated surgery is becoming more prevalent in medical school instruction, allowing for the incorporation of monitoring methods to identify trainees who require additional support and track their progress. This information could also be utilized in the development of patient safety policies, much like how research on fatigue led to regulations regarding safe working hours for doctors.

Leff stated that framing the situation as a means of assisting individuals in becoming their best selves as doctors, while also focusing on patient safety, will lead to a higher acceptance. However, if these measures are employed to determine one’s capability, it can create issues.

At the moment, it is not feasible to monitor brain activity in real-time during surgical procedures. It may take more than ten years for this capability to be developed. However, there are ongoing developments in brain-computer interface technology, such as non-invasive helmets that can track brain activity in people who are not undergoing medical procedures.

The Imperial team is currently exploring the potential use of transcranial direct current stimulation (tDCS), a non-invasive method, for improving performance. This approach involves applying a low-level electrical current via sponge electrodes on the scalp, resulting in a mild tingling sensation. Previous studies have shown that trainee surgeons who received tDCS while practicing suturing laparoscopically showed faster improvement and achieved a higher level of performance. However, experienced surgeons did not experience the same benefits.

According to Leff, neuro-augmentation is a difficult topic and people are hesitant to embrace it. This field may not receive much support, as it involves manipulating signals in the brain. On the other hand, fNIRS is a safe method of monitoring brain activity, which has been found to have greater acceptance among individuals.

Source: theguardian.com