Getting to grips with endoscopy - Learning endoscopic surgical skills induces bi-hemispheric plasticity of the grasping network

ABSTRACT Endoscopic surgery requires skilled bimanual use of complex instruments that extend the peri‐personal workspace. To delineate brain structures involved in learning such surgical skills, 48 medical students without surgical experience were randomly assigned to five training sessions on a virtual‐reality endoscopy simulator or to a non‐training group. Brain activity was probed with functional MRI while participants performed endoscopic tasks. Repeated task performance in the scanner was sufficient to enhance task‐related activity in left ventral premotor cortex (PMv) and the anterior Intraparietal Sulcus (aIPS). Simulator training induced additional increases in task‐related activation in right PMv and aIPS and reduced effective connectivity from left to right PMv. Skill improvement after training scaled with stronger task‐related activation of the lateral left primary motor hand area (M1‐HAND). The results suggest that a bilateral fronto‐parietal grasping network and left M1‐HAND are engaged in bimanual learning of tool‐based manipulations in an extended peri‐personal space. HIGHLIGHTSThe ventrolateral grasping network shows experience‐dependent shifts during acquisition of novel hand‐to‐tool transformations.Prolonged endoscopic skill training activates the core grasping system bilaterally.Task‐related activity increases in the left primary motor hand area scales with individual bimanual skill improvement.

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