Investigation of flow state occurrence during robotic virtual reality operations

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