Surgical skill assessment requires the development of objective metrics for improved training regimen and certification process. In this project, we sought to leverage fNIRS data within the framework of the Fundamental of Laparoscopy program to 1) classify the subject's expertise level (n=16), 2) monitor surgical skill acquisition (n=36), 3) benchmark against and/or predict the FLS score which is used for surgical certification (n=13). The data set is made open access to enable neuroscience discovery, provide test beds for improved data analysis and provide data to support the development of AI-based solutions in fNIRS.
Perception-action cycle-based motor learning theory postulates coupled action and perception for visuomotor learning. We hypothesized that perception-action-related brain connectivity will underpin visuomotor skill levels in a complex motor task based on this theory. We tested our hypothesis using multi-modal brain imaging on healthy human subjects (N=6 experts, N= 8 novice, all right-handed) during the performance of fundamentals of laparoscopic surgery (FLS) "suturing and intracorporeal knot-tying" task. We investigated dynamic directed brain networks using nonoverlapping sliding window-based spectral Granger causality (GC) from simultaneously acquired electroencephalogram (EEG), and functional near-infrared spectroscopy (fNIRS) signals. Our GC analysis on EEG signals showed the flow of information from the supplementary motor area complex (SMA) to the left primary motor cortex (LM1) that was statistically different (p <0.05) between the experts and novices. This result aligned with the perception action cycle theory where SMA is central to the orderly descent from the prefrontal to the motor cortex in Fuster's perception-action processing stages. The GC analysis of the fNIRS oxyhemoglobin signal revealed the connectivity from left to right primary motor cortex (LM1 to RM1) and LM1 to left prefrontal cortex (LPFC) that was significantly different (p <0.05) between the cohorts. Here, our preliminary results supported the involvement of perception-action-related directed brain connectivity in distinguishing the skill levels during a complex laparoscopic task that was measured with portable brain imaging during task performance. Future studies need to investigate the fusion of the EEG and fNIRS networks for the causal brain-behavior analysis of complex motor skill acquisition.
Significance: 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.
Aim: 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.
Approach: 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.
Results: 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, F ( 10,1 ) = 7495.5, p < 0.01. 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 (η2 = 0.257). Two-tailed Mann–Whitney U tests with a 95% confidence interval showed baseline equivalence and a statistically significant (p < 0.001) difference in the CPFC-SMA WPCO metrics for the physical simulator training group (0.960 ± 0.045) versus the untrained control group (0.735 ± 0.177) following training for 10 consecutive days in addition to the pretest and posttest days.
Conclusion: 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.
Access to the requested content is limited to institutions that have purchased or subscribe to SPIE eBooks.
You are receiving this notice because your organization may not have SPIE eBooks access.*
*Shibboleth/Open Athens users─please
sign in
to access your institution's subscriptions.
To obtain this item, you may purchase the complete book in print or electronic format on
SPIE.org.
INSTITUTIONAL Select your institution to access the SPIE Digital Library.
PERSONAL Sign in with your SPIE account to access your personal subscriptions or to use specific features such as save to my library, sign up for alerts, save searches, etc.