Functional brain connectivity related to surgical skill dexterity in physical and virtual simulation environments.
Functional brain connectivity related to surgical skill dexterity in physical and virtual simulation environments.
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DOI：
10.1117/1.nph.8.1.015008
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发表时间：
2021-01
期刊：
影响因子：
5.3
通讯作者：
De S
中科院分区：
文献类型：
--
作者：
Nemani A;Kamat A;Gao Y;Yucel M;Gee D;Cooper C;Schwaitzberg S;Intes X;Dutta A;De S
重要性：手术模拟器，无论是虚拟的还是物理的，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，在这些模拟环境中用于评估的指标通常是主观且不一致的。目的：我们提出了功能激活指标，来自脑成像测量，客观地评估大脑激活与手术运动技能不同程度的手术技巧的主题之间的对应关系。方法：基于36名受试者的氧合血红蛋白（HbO）的变化，使用功能性近红外光谱在前额叶皮层（PFC），初级运动皮层和辅助运动区（SMA），由于它们与运动技能学习的关系，测量皮质激活。区域间功能连接性指标，即小波相干性（WCO）和小波相位相干性来自HbO的变化，以客观地将大脑活动与手术运动技能水平相关联。结果如下：单因素多变量方差分析发现，基于专家与新手的Wilk Λ，物理模拟器的区域间WCO指标存在统计学显著差异。区域间WCO指标的部分eta平方效应量在中央前额叶皮层（CPFC）和SMA之间最高，CPFC-SMA（）。双尾Mann-Whitney U检验（95%置信区间）显示，除了测试前和测试后天数外，物理模拟器训练组（）与未经训练的对照组（）在连续10天训练后，CPFC-SMA WPCO指标具有基线等效性和统计学显著性差异（）。结论：我们表明，脑功能连接WCO度量对应于腹腔镜物理模拟器中的手术运动技能。在腹腔镜物理模拟器中，表现出专业手术运动技能的受试者的CPFC和SMA之间的功能连接低于未经培训的受试者。
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, , . 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. 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.