Spatial cognition in surgical practice: exploring the influence and development of spatial cognitive processes in laparoscopic skill learning

Primum non nocere ("first, do no harm") serves as a reminder that patient safety
and wellbeing lie at the heart of any medical practice. Yet, it also advocates the
importance of conducting high-quality research to better understand how patient
safety could be maximised. Laparoscopy is a minimally invasive surgery that offers
numerous advantages to the patient, yet, at the surgeons' expense. This technically
demanding technique is plagued with a unique set(s) of visuospatial and
psychomotor complexities, all rending laparoscopy difficult to learn, perform and
master. As a consequence, patient safety can become compromised. The central
role of spatial cognition in enabling laparoscopic skill acquisition and improving
performance has already been established. Yet, several critical questions remain;
(1) which specific spatial cognitive skills are important for laparoscopy (2) how
these relate to laparoscopic expertise, and (3) how these develop, and influence,
the acquisition of laparoscopic competence over time in actual residency surgeons
currently training in the operating theatre. This doctoral thesis aimed to address
these empirical shortcomings by comprehensively exploring how, and in which
context, spatial cognitive processes develop and influence skills acquisition in
laparoscopic surgery. Four distinct, yet interrelated, exploratory studies were
conducted to determine (1) the current status quo of laparoscopic education in
Germany, (2) establish a conceptualisation and classification framework of
laparoscopic competence, (3) explore whether laparoscopic surgeons of varying
expertise levels are expert patial thinkers, and (4) longitudinally explore the
develop and influence of visuospatial abilities on laparoscopic skill acquisition over
27 months. The findings reveled that whereas different abilities are called on at
different stages of laparoscopic skill acquisition, spatial visualisation shows an
enduring influence over laparoscopic performance and is closely related with
laparoscopic competence and expertise. Together, these findings carry important
theoretical and clinical implications for both psychology and surgical education
alike, as they inform our empirical understanding of the malleability and structure
of spatial processes and how these develop and influence the acquisition of
laparoscopic competence in the operating theatre.