Continuous monitoring of mental load during virtual simulator training for laparoscopic surgery, reflects laparoscopic dexterity. A comparative study using a novel wireless device. Maxim Bez 1† , Neta B. Maimon 2,3†* , Denis Ddobot 4,5 , Lior Molcho 3 , Nathan Intrator 3,6 , Eli Kakiashvilli 5 , and Amitai Bickel 4,5 1 Medical Corps, Israel Defense Forces, Ramat Gan, Israel. 2 The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel. 3 Neurosteer LTD, Herzliya, Israel. 4 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel. 5 Department of Surgery A, Galilee Medical Center, Nahariya, Israel. 6 Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel. † These authors have contributed equally to this work and share first authorship * Correspondence: Neta B. Maimon netacoh3@mail.tau.ac.il Keywords: mental load 1, cognitive load 2, surgical simulator 3, EEG biomarker 4, brain assessment 5, laparoscopic opperations6 Abstract Introduction: Cognitive Load Theory (CLT) relates to the efficiency of individuals to manipulate the limited capacity of working memory load. Repeated training generally results in individual performance increase and cognitive load decrease, as measured by both behavioral and neuroimaging methods. One of the known biomarkers for cognitive load is frontal theta band, measured by the EEG. As simulation-based training is an effective tool for acquiring practical skills, specifically to train new surgeons in a controlled and hazard-free environment, it is important to measure participants’ cognitive load to decide whether they are ready to go into a real surgery. In the present study we measured performance on a surgery simulator of medical students and interns, while their brain activity was monitored by a single-channel EEG device. Methods: Thirty-eight medical students and interns were recruited to 3 experiments examining their behavioral performance undergoing a task with the Simbionix LAP MENTOR™ simulator, while their brain activity was measured using a single-channel EEG device with novel signal processing (Aurora by Neurosteer®). On each experiment, participants performed 3 repeats of a simulator task using laparoscopic hands. The time retention between the task was different on each experiment, to examine changes in performance and cognitive load biomarkers that occur during the task or as a results of night sleep consolidation.