Emotional visual stimuli and simulated laparoscopic surgical performance: A pilot cohort study

Andrew Keenlyside (Lead / Corresponding author), Beatrice Rae, Paul M. Brennan, Mark A. Hughes

Research output: Contribution to journalArticlepeer-review


Background: Exposure to stress prior to or during surgery can negatively impact performance. Management of stress is an essential non-technical skill required for safe practice. The effects of exposure to emotional visual stressors on surgical performance are poorly understood. This study aims to develop a model to investigate effects of emotive visual stimuli on simulated laparoscopic performance.

Methods and materials: A single-centre cohort study. Thirty novice, simulator-naïve medical students were randomly allocated to view either positive, negative, or neutral emotional images (sourced from validated image registry). Participants focused for 5 s on the image before completing a peg-threading laparoscopic task. Time, instrument distance, speed, acceleration, motion smoothness, and ambidexterity were recorded automatically with instrument tracking software. 8 task cycles were completed; 3 control practices followed by 5 with the stimuli, according to group allocation.

Results: The final performance metrics of students (time, distance, speed, and motion smoothness) were not significantly different when comparing positive and neutral stimuli groups to those shown negative stimuli. However, changes were seen in the rate of performance improvements (positive: p = 0.711, p = 0.837, p = 0.297, and p = 0.393) (neutral: p = 0.285, p = 0.918, p = 0.835, and p = 0.396). Participation improved performance metrics overall (p=<0.001, p=<0.001, p = 0.088, p = 0.025, p=<0.001).

Conclusion: Model systems may be valuable for investigating the impact of stress on surgeon performance. The effect of emotive visual stimuli on surgical performance is complex. This model may aid the further exploration of these relationships and ultimately can provide an environment in which surgeons can develop strategies to mitigate the adverse effect of stressors.

Original languageEnglish
Number of pages9
JournalSurgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Early online date17 Jul 2023
Publication statusE-pub ahead of print - 17 Jul 2023


  • Stress
  • Simulation
  • Surgical performance
  • Laparoscopy

ASJC Scopus subject areas

  • Surgery


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