Quantitative neuromuscular assessment of fatigue and its impact on simulated surgical performance in minimally invasive surgery

• Grant number: 24/10013-7
• Support Opportunities: Research Grants - Young Investigators Grants
• Start date: November 01, 2025
• End date: October 31, 2028
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Marina Roizenblatt
• Grantee: Marina Roizenblatt
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil
• City of the host institution: São Paulo
• Associated researchers: Arturo Forner Cordero ; Everson Luiz de Almeida Artifon ; Mauricio Maia ; Michel Eid Farah ; Rafael Traldi Moura ; Rubens Belfort Mattos Junior

Abstract

Minimally invasive surgery encompasses medical specialties that require extreme precision, such that microscopic intraoperative errors can result in disastrous and irreversible anatomical and functional consequences for patients. Moreover, the surgeons' experience level plays a significant role in surgical outcomes, a phenomenon particularly pronounced in the early stages of surgical training. In addition to short surgical experience, the literature cites muscular and cognitive fatigue as other condition potentially associated with worsened manual dexterity. Regarding fatigue, an electroencephalography (EEG) study is a non-invasive method capable of assessing mental fatigue and drowsiness. This exam has been used across several domains to study performance in manual tasks perceived as challenging both physically and cognitively. On the other hand, electromyography (EMG) is an exam capable of quantifying a decrease in the capacity for motor force generation. In this context, the current literature lacks objective evaluations of the effect of fatigue on postoperative outcomes in minimally invasive surgery. The present study aims to establish a temporal cutoff point for the intraoperative moment at which EEG and EMG findings, as well as simulated surgical performance, assessed using the Eyesi ophthalmic simulator and the Robotix Mentor general surgery robotic simulator, indicate a decline in surgical precision due to fatigue in a population of surgeons in training. Furthermore, we aim to quantify the effect of weight-adjusted masked caffeine intake after a long day of simulated surgeries. These findings can potentially guide novice surgeons in planning the maximal number of hours they can operate without compromising patients' surgical outcomes. (AU)