SynthesisThe British journal of surgery2018
Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload.
Synthesis in The British journal of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04505956 (Prospective Randomized Double Blind Clinical Trial to Compare Holmium Laser Lithotripsy With and Without Moses Laser Technology for the Ureteroscopic Treatment of Nephrolithiasis), which is not on this map. Cited by 108 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Prospective Randomized Double Blind Clinical Trial to Compare Holmium Laser Lithotripsy With and Without Moses Laser Technology for the Ureteroscopic Treatment of Nephrolithiasis
Who cites it
108 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Evaluating the CorPath GRX robotic system in cerebral aneurysm embolization and diagnostic angiography: a systematic review and single-arm meta-analysis.Journal of robotic surgery · 2026Pooled it
- Impact of surgical non-technical skills on clinical outcomes: systematic review.The British journal of surgery · 2025Pooled it
- Comparison of cognitive workload between very short answer questions and multiple-choice questions: an eye-tracking experiment.Medical education online · 2026Trial
- Simulation training with haptic feedback of instrument vibrations reduces resident workload during live robot-assisted sleeve gastrectomy.Surgical endoscopy · 2025Trial
- Short-term outcomes of preoperative computed tomography angiography versus standard assessment in patients with BMI ≥ 25.0 kg/mGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2025Trial
- Robotic-assisted versus laparoscopic bowel anastomoses: randomized crossover in vivo experimental study.Surgical endoscopy · 2023Trial
- Accelerated Skills Acquisition Protocol (ASAP) in optimizing robotic surgical simulation training: a prospective randomized study.World journal of urology · 2020Trial
- 2D versus 3D laparoscopic total mesorectal excision: a developmental multicentre randomised controlled trial.Surgical endoscopy · 2019Trial
- Automated intracorporeal tool exchange with the Symphera multi-tool prototype: a crossover evaluation of efficiency and surgeon workload in a porcine laparoscopic model.Surgical endoscopy · 2026Article
- Ergonomic impact of closed-console (Da Vinci Xi) versus open-console (Hugo RAS) robotic systems: an ex vivo randomized crossover controlled trial.Surgical endoscopy · 2026Article
- Assessment methods for surgeons' ergonomics in the operating room: a scoping review.Surgical endoscopy · 2026Article
- Time neutrality and reduced ecological burden - handheld robotic-assisted total knee arthroplasty improves operating room efficiency compared with manual total knee arthroplasty.International orthopaedics · 2026Article
- Instructional Design for Surgical Novices Based on Cognitive Load Theory: Implications for Urologic Surgery Training.International journal of urology : official journal of the Japanese Urological Association · 2026Review
- Three-dimensional image guidance using instrument tracking facilitates intraoperative resection-line determination during robot-assisted partial nephrectomy.Journal of robotic surgery · 2026Article
- Deep-learning segmentation to guide bladder neck recognition in robot-assisted radical prostatectomy.BJU international · 2026Article
- HRV-Based Surrogate Classification in Surgical Environments Using Personalised Labelling and Sequence Modelling.Sensors (Basel, Switzerland) · 2026Article
- ECG-Only Cognitive Workload State Classification in Laparoscopic Training Using Raw and Recurrence-Plot Representations.Sensors (Basel, Switzerland) · 2026Article
- The Effect of Task Demand on EEG Responses to Irrelevant Sound and Speech in Simulated Surgical Environments.Psychophysiology · 2026Article
- Gaze Allocation and Performance Across Task-Demand Conditions During Squat-Based Exergaming: Pilot Study Using Eye Tracking.JMIR rehabilitation and assistive technologies · 2026Article
- Heart Rate Variability and Body Motion as Digital Biomarkers of Task Workload During Military En Route Critical Care Simulations.Sensors (Basel, Switzerland) · 2026Article
48 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundSurgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different methods used to assess surgeons' cognitive load, and a critique of the reliability and validity of current assessment metrics.
methodsA search strategy encompassing MEDLINE, Embase, Web of Science, PsycINFO, ACM Digital Library, IEEE Xplore, PROSPERO and the Cochrane database was developed to identify peer-reviewed articles published from inception to November 2016. Quality was assessed by using the Medical Education Research Study Quality Instrument (MERSQI). A summary table was created to describe study design, setting, specialty, participants, cognitive load measures and MERSQI score.
resultsOf 391 articles retrieved, 84 met the inclusion criteria, totalling 2053 unique participants. Most studies were carried out in a simulated setting (59 studies, 70 per cent). Sixty studies (71 per cent) used self-reporting methods, of which the NASA Task Load Index (NASA-TLX) was the most commonly applied tool (44 studies, 52 per cent). Heart rate variability analysis was the most used real-time method (11 studies, 13 per cent).
conclusionSelf-report instruments are valuable when the aim is to assess the overall cognitive load in different surgical procedures and assess learning curves within competence-based surgical education. When the aim is to assess cognitive load related to specific operative stages, real-time tools should be used, as they allow capture of cognitive load fluctuation. A combination of both subjective and objective methods might provide optimal measurement of surgeons' cognition.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.