Immersive training: Breaking the bubble and measuring the heat

J.R. Pluyter, A.F. Rutkowski, J.J. Jakimowicz

Research output: Contribution to journalArticleScientificpeer-review

16 Citations (Scopus)


Minimal access surgery and, lately, single-incision laparoscopic procedures are challenging and demanding with regard to the skills of the surgeon performing the procedures. This article presents the results of an investigation of the performance and attention focus of 21 medical interns and surgical residents training in an immersive context. That is, training ‘in situation’, representing more realistically the demands imposed on the surgeons during minimal access surgery.

Twenty-one medical interns and surgical residents participated in simulation trainings in an integrated operating room for laparoscopic surgery. Various physiological measures of body heat expenditure were gathered as indicators of mental strain and attention focus.

The results of the Mann–Whitney test indicated that participants with a poor performance in the two laparoscopic cholecystectomy cases had a significantly (U = 3, p = 0.038) higher heat flux at the start of the procedure (mean 107.08, standard deviation [SD] 24.34) than those who excelled in the two cases (mean 62.64, SD 23.41). Also, the average frontal head temperature of the participants who failed at the task was significantly lower (mean 33.27, SD 0.52) than those who performed well (mean 33.92, SD 0.27).

Surgeons cannot operate in a bubble; thus, they should not be trained in one. Combining heat flux and frontal head temperature could be a good measure of deep involvement and attentional focus during performance of simulated surgical tasks.
Original languageEnglish
Pages (from-to)1545-1554
JournalSurgical Endoscopy
Issue number5
Early online date8 Jan 2014
Publication statusPublished - May 2014


  • attention focus
  • cognitive absorption
  • immersive training
  • simulation training
  • mental strain


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