Nemani Arun, Kamat Anil, Gao Yuanyuan, Yucel Meryem, Gee Denise, Cooper Clairice, Schwaitzberg Steven, Intes Xavier, Dutta Anirban, De Suvranu
Rensselaer Polytechnic Institute, Center for Modeling, Simulation, and Imaging in Medicine, Troy, New York, United States.
Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts, United States.
Neurophotonics. 2021 Jan;8(1):015008. doi: 10.1117/1.NPh.8.1.015008. Epub 2021 Mar 3.
Surgical simulators, both virtual and physical, are increasingly used as training tools for teaching and assessing surgical technical skills. However, the metrics used for assessment in these simulation environments are often subjective and inconsistent. We propose functional activation metrics, derived from brain imaging measurements, to objectively assess the correspondence between brain activation with surgical motor skills for subjects with varying degrees of surgical skill. Cortical activation based on changes in the oxygenated hemoglobin (HbO) of 36 subjects was measured using functional near-infrared spectroscopy at the prefrontal cortex (PFC), primary motor cortex, and supplementary motor area (SMA) due to their association with motor skill learning. Inter-regional functional connectivity metrics, namely, wavelet coherence (WCO) and wavelet phase coherence were derived from HbO changes to correlate brain activity to surgical motor skill levels objectively. One-way multivariate analysis of variance found a statistically significant difference in the inter-regional WCO metrics for physical simulator based on Wilk's Λ for expert versus novice, , . Partial eta squared effect size for the inter-regional WCO metrics was found to be highest between the central prefrontal cortex (CPFC) and SMA, CPFC-SMA ( ). Two-tailed Mann-Whitney U tests with a 95% confidence interval showed baseline equivalence and a statistically significant ( ) difference in the CPFC-SMA WPCO metrics for the physical simulator training group ( ) versus the untrained control group ( ) following training for 10 consecutive days in addition to the pretest and posttest days. We show that brain functional connectivity WCO metric corresponds to surgical motor skills in the laparoscopic physical simulators. Functional connectivity between the CPFC and the SMA is lower for subjects that exhibit expert surgical motor skills than untrained subjects in laparoscopic physical simulators.
虚拟和实体手术模拟器越来越多地被用作教学和评估手术技术技能的培训工具。然而，这些模拟环境中用于评估的指标往往主观且不一致。我们提出了基于脑成像测量得出的功能激活指标，以客观评估不同手术技能水平的受试者大脑激活与手术运动技能之间的对应关系。由于前额叶皮质（PFC）、初级运动皮质和辅助运动区（SMA）与运动技能学习相关，因此使用功能近红外光谱法测量了36名受试者基于氧合血红蛋白（HbO）变化的皮质激活情况。从HbO变化中得出区域间功能连接指标，即小波相干（WCO）和小波相位相干，以客观地将大脑活动与手术运动技能水平相关联。单因素多变量方差分析发现，基于威尔克斯Λ，专家与新手在实体模拟器的区域间WCO指标上存在统计学显著差异。发现区域间WCO指标的偏η平方效应大小在中央前额叶皮质（CPFC）和SMA之间最高，即CPFC - SMA（ ）。除了前测和后测日外，连续训练10天后，使用95%置信区间的双尾曼 - 惠特尼U检验显示，实体模拟器训练组（ ）与未训练对照组（ ）在CPFC - SMA小波相位相干指标上基线等效且存在统计学显著差异（ ）。我们表明，大脑功能连接WCO指标与腹腔镜实体模拟器中的手术运动技能相对应。在腹腔镜实体模拟器中，表现出专家级手术运动技能的受试者的CPFC和SMA之间的功能连接低于未训练的受试者。
