Human Factors

Cognitive ability and expertise in learning to perform minimally invasive surgery


Prof. dr. Jan Maarten Schraagen (Cognitive Psychology and Ergonomics, UT)

Dr. Marleen Groenier (Technical Medicine, UT)

Dr. Bob Geelkerken (Vaatchirurgie, Medisch Spectrum Twente)

Prof. dr. Isabelle van Herzeele (Vaatchirurgie, Universitair Ziekenhuis Gent, België)


The aim of the study is to understand the relationship between cognitive ability and experience in acquiring complex endovascular skill. The results of this study are used to further develop efficient and effective endovascular simulation-based training.


Minimally invasive surgery (MIS) has benefits for patients, but places additional burdens on the surgeons, because they have to work with reduced tactile feedback and loss of 3D vision. Hand-eye coordination is different for minimally invasive procedures than open procedures because the instruments need to be navigated in a 3D environment while the surgeon is looking at a 2D image on a screen. Some trainees adapt to the perceptual and psychomotor difficulties of minimally invasive procedures better than others. The differences in the time to learn minimally invasive procedures, including endovascular procedures, can in part be explained by differences in surgeons’ cognitive ability. Individuals with lower abilities struggle more to automate a skill and use more attentional resources to concentrate on the task. In addition, practice and feedback are required for progressive skill acquisition and the contribution of abilities changes from one skill acquisition stage to the next.

Figure 1. Endovascular simulator.

In the current study we investigate how experience and cognitive ability contribute to learning to perform complex endovascular skill.

Methods & Analysis

Skill acquisition of individuals with varying levels of expertise is examined. Participants practice an endovascular task on a simulator until a predefined performance goal is reached. Learning curves are analyzed in relation to the participants’ cognitive ability and prior experience.

Additional information

This project is a collaboration between the department of Cognitive Psychology and Ergonomics, the Experimental Center for Technical Medicine and the department of Vascular Surgery of the Medisch Spectrum Twente hospital.


Gallagher, A.G., Ritter, E.M., Champion, H., Higgins, G., Fried, M.P., Moses, G., Smith, C.D. & Satava, R.M. (2005). Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Annals of surgery, 241, 364-372.

Desender, L. M., Van Herzeele, I., Aggarwal, R., Vermassen, F. E. G., & Cheshire, N. J. (2011). Training with simulation versus operative room attendance. Journal of Cardiovascular Surgery, 52, 17-37.