Increasing Operating Room Efficiency: Unlocking the EEG potential for Enhanced Surgical Precision

  • out-of-lab
  • VR
  • multimodal

The integration of mobile EEG and VR in testing new surgical lighting systems marks a significant advancement in medical research. The operating room (OR) is a critical environment where precision is paramount. It has been previously reported that surgeon’s precision is highly influenced by surgical lightning.

Traditional surgical lighting systems (SLS) need manual adjustments. This can potentially lead to doctor’s distractions and contamination. This challenge resulted in this innovative research using mobile EEG-VR to revolutionize how surgical lighting is managed, aiming to enhance both safety and performance.

EEG VR Operating room

The Challenge of Traditional Surgical Lighting

Surgical procedures, especially complex ones like organ transplantations, demand high levels of skill and focus. In such high-stakes settings, even the lighting system can impact the performance. Traditional SLS often requires manual adjustments, potentially distracting surgeons and introducing risks of contamination. This necessity for frequent adjustments (every 7.5 minutes on average) raises concerns about the efficacy and safety of current lighting practices, particularly given the possible presence of pathogens on SLS handles.

Technological Innovations in the Operating Room

Recent advances in medical technology have significantly alleviated the pressures faced by surgical teams. From robotic surgery enhancing procedural techniques to AI-supported diagnostics improving patient outcomes, these innovations aim to streamline operations and reduce the time patients spend under anaesthesia. Yet, despite these advancements, the fundamental need for adequate surgical lighting often receives less attention, with most ORs still relying on traditional overhead lamps.

Role of mobile EEG-VR in Surgical Lighting Optimization

Mobile EEG recordings and VR simulations are pivotal in this study. EEG is utilized to measure the cognitive load of operating with traditional versus smart lighting systems. This way it is possible to get insights into the mental effort required by each. Meanwhile, VR offers a sophisticated platform for simulating different lighting scenarios without the risks and costs associated with real-life testing. These technologies together enable a comprehensive evaluation of the proposed lighting system’s impact on surgical performance and safety.

Experiment Setup and Equipment:

The study aimed to evaluate the impact of manual versus automatic adjustments of the SLS on the performance and cognitive load of OR personnel. Utilizing both real-life setups and virtual reality (VR) simulations, the research compared traditional manual interactions with the novel automated system. Participants’ brain activities were monitored using electroencephalography (EEG) during these tests to measure cognitive load and task performance effectively.

EEG and VR in Operating Room
The setup included a VR headset integrated with a SMARTING EEG device for comprehensive neurophysiological monitoring.

The testing was performed in two scenarios:

Real-Life Testing

  • Conducted at the University of Oldenburg’s Department of Visceral Surgery, PIUS Hospital Oldenburg, the study involved two distinct sessions. Participants performed a neuropsychological test known as the D2 test of attention, which assesses visual and sustained attention through a timed task of identifying specific characters.
  • Each session varied in the requirement to adjust the SLS manually, allowing comparison between static and manually adjusted lighting conditions.

Virtual Reality Testing:

  • A VR simulation created a comparable OR environment where participants encountered the same task under different lighting conditions. This simulation used high-end VR equipment to recreate an OR setting, complete with a digitally rendered operating table and an occluder simulating a human body that could cast shadows.
  • The setup was designed to mirror real-life scenarios, allowing participants to manually adjust the SLS using VR controllers or experience automatic adjustments by the novel SLS system.
VR EEG experiment
The VR simulation replicated an operating room (OR) scenario where the sole light source was the surgical lighting system (SLS). In the simulation, the environment was designed to mimic a typical OR with dark surroundings focused around a brightly illuminated operating table.

The study ensured a clear separation of participants into either the real-life or VR testing groups to avoid learning effects influencing the outcomes.

EEG and Behavioural Testing

  • EEG data were recorded using a mobile EEG technology and processed to analyse frequency bands associated with cognitive load (alpha, beta, and theta). Special attention was paid to the initial moments after SLS adjustments to capture immediate cognitive responses.
  • The D2 test required participants to identify and mark specific characters under timed conditions, with performance metrics including accuracy and the number of correct identifications.
D2 Test
In the virtual reality simulation, the digital version of the D2-test, a cognitive assessment tool, was displayed on a simulated operating table.

Data Analysis

  • Both EEG and behavioural data underwent statistical analysis using paired t-tests and ANOVAs to compare the four conditions: constant illumination, manual adjustment, and their VR counterparts.
  • Results aimed to quantify the mental and performance impacts of manual versus automated SLS adjustments, providing insights into the potential benefits of the novel SLS in reducing cognitive load and enhancing surgical performance.

Main Findings

The findings revealed that SLS manual adjustments didn’t impact performance quality. Instead, it increased cognitive load, leading to quicker fatigue among medical personnel. The smart SLS, on the other hand, maintained performance quality while reducing cognitive load. This finding indicates a more efficient approach for the OR.

Behavioural Results

No significant differences were observed between control and experimental conditions during real-life and VR testing, in terms of the number of items processed or the accuracy of tasks. However, a trend suggested slightly better performance in experimental conditions, with fewer missed targets, indicating that the novel SLS might slightly improve performance efficiency.

EEG Results

EEG measurements revealed minor but consistent changes in alpha and beta brain wave activities immediately after adjusting the SLS. Particularly a significant decrease in alpha power in frontal brain regions during real-life interactions and less pronounced in VR settings.

EEG Alpha
Alpha-band Activity Reduction in EEG Testing: During real-life EEG testing, there was a significant reduction in alpha-band activity at electrode positions Fp1 and Fp2; however, these changes did not reach statistical significance, suggesting less impact on alpha activity in the simulated environment.


EEG Beta band
Beta-band Activity Increase in EEG Testing: The study observed a significant increase in beta-band activity at electrode position P8, with a 23% rise noted during manual interaction with the surgical lighting system (SLS).

These findings suggest that manual adjustments increase cognitive load, albeit briefly.

A Deeper Dive into the Results

The integration of EEG and VR in the study highlights the potential benefits of a smart SLS in reducing mental fatigue and maintaining efficiency in the OR.

The study analysed the additional mental load imposed by manual interactions with the SLS in the OR.

While the overall performance was not detrimentally affected—thanks to possible compensatory efforts by participants—the EEG data indicated increased cognitive strain during manual adjustments.

This strain was reflected in increased beta activity at motor-related brain sites and decreased alpha activity at attention-related sites, emphasizing the cognitive and physical demands of manual SLS adjustments.

Embracing the Future of Surgical Lighting

The study demonstrates the potential of EEG and VR in optimizing surgical lighting systems. Combining EEG and VR offers a glimpse into the future of OR efficiency.

The proposed touch-free SLS not only enhances hygiene but also alleviates the mental burden on surgical staff.

Although the study’s sample size was limited, its insights pave the way for further research and potential real-life implementation of smart SLS. This could significantly improve surgical procedures’ safety and efficiency.

In conclusion, the study highlights the crucial role of EEG and VR in developing smart surgical lighting systems, enhancing performance and safety in the operating room.

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