This single-blinded, three-arm randomized controlled trial evaluated the effects of different auditory environments on laparoscopic task performance and mental workload among novice surgeons in a simulated setting. Sixty participants were randomly assigned to one of three groups: preferred music, white noise, or silent control. Participants completed standardized laparoscopic simulation tasks. The primary outcome was task completion time. Secondary outcomes included mental workload assessed using the Surgical Task Load Index (SURG-TLX), perceived stress, and heart rate variability. The study aimed to determine whether preferred music enhances technical performance while reducing cognitive workload during laparoscopic simulation.
Background Laparoscopic surgery requires advanced psychomotor coordination, sustained concentration, and effective stress management. Environmental auditory stimuli may influence cognitive performance and operative efficiency, yet evidence remains limited, particularly among novice surgeons. Objective To compare the effects of preferred music, white noise, and silence on laparoscopic performance and mental workload. Methods Participants were randomized equally into three intervention groups. All participants performed standardized laparoscopic simulation exercises under their assigned auditory condition. Technical performance, subjective workload, and physiological stress were evaluated using validated assessment tools. Hypothesis Preferred music improves laparoscopic performance and reduces mental workload compared with white noise or silence.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
TRIPLE
Enrollment
60
Participants listened to their own self-selected preferred music through headphones while performing standardized laparoscopic simulation tasks. The music was chosen by each participant before the simulation and played continuously throughout the intervention session. The simulation protocol, task instructions, and assessment procedures were identical for all study groups.
Participants listened to standardized white noise through headphones while performing standardized laparoscopic simulation tasks. The white noise was played continuously throughout the intervention session. All simulation tasks, instructions, and assessment procedures were identical to those used in the other study groups.
Participants performed the standardized laparoscopic simulation tasks under a silent environment without exposure to any auditory stimulus. All simulation tasks, instructions, and assessment procedures were identical to those used in the intervention groups.
Hospital Universiti Sains Malaysia
Kubang Kerian, Kelantan, Malaysia
Laparoscopic task completion time
Time required for participants to complete the standardized laparoscopic simulation task under the assigned auditory condition (preferred music, white noise, or silent control). Task completion time was recorded in seconds using the laparoscopic simulator's timing system.
Time frame: Immediately upon completion of the laparoscopic simulation task (Day 1).
SURG-TLX score
Mental workload measured using the Surgical Task Load Index (SURG-TLX) questionnaire. The SURG-TLX generates a weighted overall workload score ranging from 0 to 10, with higher scores indicating greater mental workload (worse outcome).
Time frame: Immediately after completion of the laparoscopic simulation task (Day 1).
Heart Rate Variability
Heart rate variability parameters were measured using a validated heart rate monitoring device before and after the laparoscopic simulation to assess autonomic nervous system activity. Outcomes included time-domain and frequency-domain HRV indices. The direction of better or worse outcome depends on the specific HRV parameter analyzed.
Time frame: Baseline (before simulation) and immediately after completion of the laparoscopic simulation task (Day 1).
Perceived Stress Score
Subjective stress assessed using the Visual Analogue Scale (VAS) ranging from 0 to 10, where 0 indicates no perceived stress and 10 indicates the highest perceived stress. Higher scores indicate greater perceived stress (worse outcome).
Time frame: Baseline (before simulation) and immediately after completion of the laparoscopic simulation task (Day 1).
Technical Performance Score
Overall technical performance assessed using the LapSim laparoscopic simulator. The LapSim overall performance score is an automatically generated composite score based on performance metrics including task completion, instrument handling, movement efficiency, accuracy, and errors. Scores range from 0 to 100, with higher scores indicating better laparoscopic technical performance.
Time frame: Baseline (before randomization) and immediately upon completion of the intervention laparoscopic simulation task (Day 1).
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