Measuring Bound Attention During Complex Liver Surgery Planning: Feasibility Study

Schneider, Tim; Cetin, Timur; Uppenkamp, Stefan; Weyhe, Dirk; Muender, Thomas; Reinschluessel, Anke V; Salzmann, Daniela; Uslar, Verena · 2025 · Crossref

DOI: 10.2196/62740

archive: archived pipeline: cataloged verified

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Summary

This feasibility study addresses the need for objective evaluation of human-machine interaction in surgical planning, specifically assessing the cognitive workload associated with augmented reality (AR) and virtual reality (VR) technologies. While AR and VR offer potential benefits for complex liver surgery planning through 3D visualization, they may also increase surgeon workload and stress, potentially offsetting clinical advantages. The study aimed to establish a method for objectively determining this additional workload using electroencephalography (EEG) and comparing it with subjective self-reports, thereby validating a neuroergonomic approach to evaluating surgical technologies. The researchers conducted an experiment with nine experienced visceral surgeons who performed mock preoperative planning for liver resection using two anonymized patient cases. Participants completed the planning tasks under three randomized conditions: using AR glasses (Microsoft HoloLens 2), VR glasses (HTC VIVE Pro), and conventional 2D radiological images on a PC. During each task, continuous EEG signals were recorded using a passive auditory oddball paradigm, where participants focused on surgical planning while passively listening to frequent and rare auditory stimuli. Subjective workload was assessed using the NASA-Task Load Index (NASA-TLX) questionnaire after each condition. EEG data were preprocessed to analyze auditory evoked potentials (AEPs) and event-related potentials (ERPs), specifically examining components P1, N1, P2, and P3. The results indicated that the AR condition elicited the highest subjective workload, with median NASA-TLX scores for mental demand (75), effort (55), and frustration (40) significantly higher than those for VR and PC conditions. Physically, the PC condition had the lowest demand. Electrophysiologically, the AR condition showed a trend toward lower amplitudes for N1 and P3 components at central electrodes, suggesting higher cognitive resource allocation to the primary task and thus higher workload. In contrast, VR conditions did not show noticeable EEG differences compared to the conventional PC condition, except for significantly earlier P1 latencies at the Fz electrode (mean 75.3 ms) compared to the PC condition (mean 99.4 ms). The alignment between subjective NASA-TLX scores and objective EEG findings supported the validity of the study design. The study concludes that VR glasses likely induce lower stress levels than AR glasses during surgical planning, potentially due to the immersive 3D visualization capabilities of VR. The congruence between subjective self-reports and objective EEG measurements confirms that passive auditory oddball paradigms combined with EEG can effectively assess mental workload in clinical settings. This approach offers a robust, bias-free alternative to subjective questionnaires for evaluating the ergonomics and cognitive impact of emerging surgical technologies, facilitating safer integration of AR and VR into clinical practice.

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Topics

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• neuro workload indices
• workload measurement

Information type

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• Empirical Findings: self report data, physiological data