Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery



+44 (0)20 3312 1947d.leff




Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus






BibTex format

author = {Modi, H and Singh, H and Darzi, A and Leff, D},
doi = {10.1097/SLA.0000000000004208},
journal = {Annals of Surgery},
pages = {648--657},
title = {Multitasking and time pressure in the operating room: impact on surgeons’ brain function},
url = {},
volume = {272},
year = {2020}

RIS format (EndNote, RefMan)

AB - Objective:To assess the impact of multitasking and time pressure on surgeons’ brain function during laparoscopic suturing.Summary Background Data:Recent neuroimaging evidencesuggests that deterioration in surgical performance under time pressure is associated with deactivationof the prefrontal cortex (PFC),an area important for executive functions. However, the effect ofmultitasking on operator brain functionremains unknown.Methods:29surgical residentsperformed anintracorporealsuturing task under fourconditions: 1) self-pacedsuturing,2) time-pressured suturing, 3) self-paced suturingplus decision-making, and 4) time-pressured suturing plus decision-making. Subjectiveworkload was quantified using the Surgical Task Load Index. Technical skill was objectively assessed using task progression scores, error scores, leak volumes, and knot tensile strengths. PFC activation was measuredusing optical neuroimaging. Results:Compared with self-paced suturing, subjective workload(au)was significantly greater in time-pressuredsuturing (146.0 vs. 196.0), suturing with decision-making (146.0 vs.182.0), and time-pressuredsuturing with decision-making (146.0 vs.227.0). Technical performance duringcombined suturing and decision-making taskswas inferiortosuturing alone undertime pressure orself-paced conditions(p<0.001).Significant dorsolateral PFC (DLPFC) activations were observed during self-paced suturing, and ventrolateral PFC (VLPFC) deactivations were identified during time-pressuredsuturing. However, suturing in conjunction withdecision-making resulted in 2significantdeactivation across boththe VLPFC and DLPFC (p<0.05). Random effects regression analysis confirmed decision-making predicts VLPFC and DLPFC deactivation (z=-2.62, p<0.05).Conclusions:Performance degradation during high workload conditions is associated with deactivation of prefrontal regions important fo
AU - Modi,H
AU - Singh,H
AU - Darzi,A
AU - Leff,D
DO - 10.1097/SLA.0000000000004208
EP - 657
PY - 2020///
SN - 0003-4932
SP - 648
TI - Multitasking and time pressure in the operating room: impact on surgeons’ brain function
T2 - Annals of Surgery
UR -
UR -
VL - 272
ER -