Modi Hemel N, Osborne-Grinter Maia, Patel Ronak, Darzi Ara, Leff Daniel R, Singh Harsimrat
Neuroergonomics and Perception Laboratory, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
The Hamlyn Centre, Imperial College London, London, United Kingdom.
Front Hum Neurosci. 2024 Oct 21;18:1386005. doi: 10.3389/fnhum.2024.1386005. eCollection 2024.
Inadequate exposure to real-life operating can impede timely acquisition of technical competence among surgical residents, and is a major challenge faced in the current training climate. Mental rehearsal (MR)-the cognitive rehearsal of a motor task without overt physical movement-has been shown to accelerate surgical skills learning. However, the neuroplastic effect of MR of a complex bimanual surgical task is unknown. The aim of this study is to use functional near-infrared spectroscopy (fNIRS) to assess the impact of MR on prefrontal and motor cortical activation during a laparoscopic knot tying task.
Twelve surgical residents performed a laparoscopic knot tying task before and after either mental rehearsal (MR, intervention group) or textbook reading (TR, control group). In both groups, fNIRS was used to measure changes in oxygenated hemoglobin concentration (HbO2) in the prefrontal (24 channels) and motor cortices (22 channels). Technical performance was measured using leak volume, objective performance score and task progression score.
MR led to a decrease in HbO (reduced activation) in the bilateral prefrontal cortex (PFC), and an increase in HbO (increased activation) in the left middle frontal gyrus, left precentral gyrus, and left postcentral gyrus. No discernible changes in activation were observed after TR in either the PFC or motor cortex. Moreover, smaller ΔHbO2 responses in the right PFC and greater ΔHbO responses in the left motor cortex were observed in the MR group compared with the TR group. Leak volume was significantly less following MR ( = 0.019), but not after TR ( = 0.347). Mean objective performance score was significantly higher following MR compared with TR ( = 0.043).
Mental rehearsal may enhance surgical skill acquisition and technical proficiency by reducing utilization of attentional resources in the prefrontal cortex and improving neural efficiency in motor areas during a laparoscopic surgical task.
缺乏实际操作经验会阻碍外科住院医师及时掌握技术能力，这是当前培训环境中面临的一项重大挑战。心理演练（MR）——在不进行明显身体动作的情况下对运动任务进行认知演练——已被证明可以加速外科技能的学习。然而，复杂双手手术任务的心理演练的神经可塑性效应尚不清楚。本研究的目的是使用功能近红外光谱（fNIRS）来评估心理演练对腹腔镜打结任务期间前额叶和运动皮层激活的影响。
12名外科住院医师在进行心理演练（MR，干预组）或阅读教科书（TR，对照组）之前和之后执行腹腔镜打结任务。在两组中，fNIRS用于测量前额叶（24个通道）和运动皮层（22个通道）中氧合血红蛋白浓度（HbO2）的变化。使用渗漏量、客观表现评分和任务进展评分来衡量技术表现。
心理演练导致双侧前额叶皮质（PFC）中HbO（激活减少）降低，以及左侧额中回、左侧中央前回和左侧中央后回中HbO（激活增加）增加。在TR后，PFC或运动皮层均未观察到明显的激活变化。此外，与TR组相比，MR组右侧PFC中ΔHbO2反应较小，左侧运动皮层中ΔHb反应较大。心理演练后的渗漏量显著更低（=0.019），但阅读教科书后则不然（=0.347）。与TR相比，心理演练后的平均客观表现评分显著更高（=0.043）。
心理演练可能通过减少前额叶皮质中注意力资源的利用并提高腹腔镜手术任务期间运动区域的神经效率来增强外科技能的获得和技术熟练程度。
