Can surgeons think and operate with haptics at the same time?

Much effort has been devoted to incorporating haptic feedback into surgical simulators. However, the benefits of haptics for novice trainees in the early stages of learning are not clear. Presumably, novices have less spare attentional resources to attend to haptic cues while learning basic laparoscopic skills. The aim of this study was to determine whether novice surgeons have adequate cognitive resources to attend to haptic information. Thirty surgical residents and attendings performed a TransferPlace task in a simulator, with and without haptics. Cognitive loading was imposed using a mental arithmetic task. Subjects performed 10 trials (five with cognitive loading and five without) with and without haptics. Results showed that all subjects performed significantly slower (27%) when they were cognitively loaded than unloaded, but equally accurately in both cases, suggesting a speed-accuracy tradeoff. On average, subjects performed 36% faster and 97% more accurately with haptics than without, even while cognitively loaded. Haptic feedback can not only enhance performance, but also counter the effect of cognitive load. This effect is greater for more experienced surgeons than less experienced ones, indicating greater spare cognitive capacity in surgeons with more experience.