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

Abstract

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.