This is a high-stakes scenario for any surgeon. His 65-year-old male patient with a high BMI and heart disease is undergoing emergency surgery for a perforated appendix.
Internal bleeding is detected, the anesthesia monitor malfunctions, and various bleepers go off before an emergency call comes in about an ectopic pregnancy in another ward.
This kind of drama plays out every day in the operating room, but in this case, the training was conducted by a team of researchers from Imperial College London who study what happens in the brain during surgeons' operations. Mary Goble, a doctor, is being cornered. Or procedures at the time of death.
Goble looks cool and calm as he laparoscopically removes his silicone appendix, fending off a barrage of distractions. But her brain activity, monitored through her hat covered with optical probes, may tell a different story.
Researchers led by Daniel Leff, principal investigator and consultant breast surgeon at Imperial College Healthcare NHS Trust, are working to detect telltale signs of cognitive overload based on brain activity. In the future, they say, this could help alert people to warning signs during surgery.
“The operating room can be a very chaotic environment, and as a surgeon, you have to stay calm and calm even when everyone is losing their lives,” Leff said. said. “Increased cognitive load has a significant impact on patient safety. There are no tools available to surgeons to know whether they are coping with the cognitive demands of their environment. Will that happen?”
In the future, Lev envisions a system that could read brain activity in real time in the operating room and initiate interventions if surgeons are at risk of overload.
“If you really like listening to Whitney Houston, you can automatically play calming music. Or you can alert the theater's head nurse to the inevitable nonsense that happens in the theater room.” We might be able to deal with it,” Lev said. “It’s like the Minority Report of surgery.”
More controversially, brain stimulation may also be used to improve surgeons' performance when they are losing focus.
The cap Goble wears uses functional near-infrared spectroscopy (fNIRS). This is a non-invasive technique that measures changes in blood oxygenation in the brain, a proxy for underlying neural activity. The research team has previously shown that when performing surgery, novice surgeons have greater brain activity in the prefrontal cortex than experienced doctors. They also found that activity in the prefrontal cortex seemed to be disrupted more easily in doctors who performed poorly in stressful situations.
The latest research attempts to map the fNIRS signs of cognitive overload, when doctors become unable to cope with the influx of information and demands and their performance begins to decline. The study will use trainee surgeons to track their brain activity and surgical performance as demands gradually increase. The simulated environment means every movement of the laparoscopic instruments can be tracked, and copper wires embedded in the silicone appendage detect whether the incision is on target.
“A lot of times you don't really see the outward signs from people,” Leff said, adding that doctors typically have a “give it up” mentality.
Dr Goble, a surgical trainee at King's College NHS Trust and a research participant, said his stress levels soared after the run-through, even though it was a simulation. “Surgery is a stressful environment,” she says. “It's easy to get really overwhelmed during night shifts, when you're alone and have to deal with competing clinical priorities. I work on my breathing as a kind of focus method.”
With the increasing use of simulated surgery in medical school education, there is potential to incorporate this type of monitoring into training to identify residents who need more support and track their progress, Leff said. It is said that there is. Future patient safety policy will be shaped by better evidence about how the operating room environment affects performance, just as findings on fatigue have led to new regulations regarding safe work patterns for physicians. may be brought about.
“I think it would be more acceptable if it was about helping people be the best doctors they can be and focusing on patient safety,” Leff said. “The moment you start using these things to say someone is competent or incompetent, you start having problems.”
It is not yet possible for surgeons to read brain activity in real time during surgery, and this application is likely to be more than a decade away. But brain-computer interface technology is rapidly advancing, including non-invasive helmets designed to measure brain activity in healthy people.
The Imperial team is also investigating the possibility of using a non-invasive technique called transcranial direct current stimulation (tDCS) to improve performance. This involves passing a weak electric current between her two sponge electrodes placed on the scalp, which only causes a slight tingling sensation. Previously, they found that residents learning laparoscopic suturing progressed faster and reached higher levels of performance if they received tDBS during their training. However, a similar effect was not seen in experienced surgeons.
“When it comes to neuroenhancement, it's certainly a more difficult field and people are more skeptical,” Leff says. “It's a difficult field to get a lot of support because you're talking about sending signals into someone's brain. fNIRS is a harmless way to monitor what's going on, and I think it's more acceptable to people. I found it easy.”
