Keywords
cognitive skills
Open Access funding enabled and organized by Projekt DEAL.Minimally invasive surgery (MIS) has replaced open procedures as the gold standard in many areas of surgery. This includes simple procedures, such as laparoscopic appendectomy or cholecystectomy [The paradigm shift in training methodology toward a competency-based approach is a consequence of increased demands for patient safety. Errors can typically occur more often during surgical training, especially during complex procedures [Currently, resident surgeons usually spend a considerable amount of time assisting and watching experienced surgeons during residency. However, the assisting residents react to the surgeon’s commands and do not necessarily make individual decisions or get involved in planning the next steps, despite being active members of the operating team. Nonetheless, these hours of assisting are of utmost importance. Actively paying attention is crucial to maximizing training effects. This skill of being aware of the current surgical step and anatomical structures at risk will be referred to as “situational awareness” (SA) in this manuscript. In its original definition, SA describes the ability to process information effectively. It depends on general cognitive skills, such as attention, (working) memory and multitasking. SA can be divided into three levels. (1) Perception of key elements in the environment. (2) Recognition of the importance of the key elements and involvement in the current situation. (3) A look into the future and the prediction of a possible outcome for the current situation. Transferred to the OR for a basic procedure, such as laparoscopic cholecystectomy (LC), those three steps could be (1) perception of the preparation status of the cystic duct, (2) recognition that the visualization of the Calot triangle is crucial before clipping and cutting and being aware that anatomical variations of vessels can be present, and (3) if the criteria of the critical view of safety are not met, severe damage of the biliary tree and hepatic blood vessels is at risk. Just as with other mental skills, SA warrants dedicated training to be effective. In addition, it has been shown that SA training for surgeons can reduce errors [