Tracking Mental Workload by Multimodal Measurements in the Operating Room

Mental workload and its effects on surgical performance are underexplored topics, despite their importance for operating room (OR) efficiency and patient safety. We developed a multimodal platform that can simultaneously collect data from electroencephalography, heart rate, breathing rate, tool handle pressure, and an eye tracker from mobile subjects. We performed experiments using the fundamentals of the laparoscopic surgery model, with 22 subjects of varying skill levels ranging from nonsurgeon to expert. The results indicated significant modulations of the measurements depending on pupil size, heart rate variability, P300 response, tool pressure, task difficulty, time on task, and skill level. These provide evidence that physiology-based metrics can be used in automated classification of fine gradations of skill, assessment and certification of surgery trainees, developing real-time flags and warnings for the OR, and validating new OR technology.