# Investigation of flow state occurrence during robotic virtual reality operations

## TL;DR

This study explores how brain activity and heart rate relate to optimal performance during virtual reality surgical training.

## Contribution

The study identifies theta brain activity as a key marker of flow state in high-performing surgeons during VR training.

## Key findings

- High performers showed significantly higher theta brain activity during VR tasks.
- VR performance scores correlated positively with flow state in high performers.
- No significant differences in heart rate were observed between performance groups.

## Abstract

Flow is the optimal mental state for peak focus and performance, positively correlating with well-being. This study investigated electroencephalographical (EEG) and circulatory heart rate (HR) markers of flow during virtual reality (VR) surgical training on the da Vinci Skills Simulator. Twenty urologic surgeons participated, categorised as High or Low Performers based on VR task scores. Generalised estimating equations and Spearman’s rank correlation were used to analyse differences in EEG, HR, Flow Short Scale scores, and professional experience. High performers exhibited significantly higher Theta activity Wald(1) = 5.96, p = .015; Wald(1) = 5.11, p < .001) and a positive correlation between VR scores and flow r(10) = 0.63, p = .048). No significant HR differences were observed. The study highlights the importance of Theta activity in achieving flow, suggesting that neurofeedback and biofeedback could provide a point of departure to enhance surgical performance and well-being of surgeons and patient health.

The online version contains supplementary material available at 10.1038/s41598-025-24215-0.