Correlation of laparoscopic experience with differential functional brain activation: a positron emission tomography study with oxygen 15-labeled water.

HYPOTHESIS Regions of functional brain activation differ between novice and expert laparoscopists. DESIGN We compared novice and expert laparoscopists using positron emission tomography (PET) during the peg transfer task of the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) protocol. The first scan (rest) was performed with the subject's eyes closed. The second scan (video 1) was performed while watching a peg transfer video. The third scan (peg 1) was acquired during the peg transfer task. The forth scan (peg 2) was performed after practicing 15 minutes. The fifth scan (video 2) was performed after peg 2 as the subject watched a video clip of a laparoscopic partial nephrectomy. The sixth scan (peg 3) was conducted during the final peg transfer task after 15 more minutes of practice. SETTING Feinstein Institute for Medical Research. PARTICIPANTS Five novice and 5 expert laparoscopists. MAIN OUTCOME MEASURES Differences in brain activation as determined by changes in regional cerebral blood flow on PET scans with oxygen 15-labeled water. RESULTS The first analysis examined group differences between the 3 peg scans and the rest scan. The novice group had a significantly (P < .001) higher activation (with deactivation in the expert group) in the left precentral gyrus and insula and the right precuneus and inferior occipital gyrus. The second analysis compared the 2 video scans and the rest scan. In contrast to the expert group, the novices had significantly (P < .001) higher activation in the right precuneus and cuneus but deactivation in the bilateral posterior cerebellum. CONCLUSIONS This study demonstrates differential regional brain activation patterns between novice and expert laparoscopists during surgery-related motor and visual association tasks.

[1]  G. Fried,et al.  Validity of the MISTELS simulator for laparoscopy training in urology. , 2005, Journal of endourology.

[2]  M. Hallett,et al.  Early consolidation in human primary motor cortex , 2002, Nature.

[3]  James R Korndorffer,et al.  Laparoscopic skills laboratories: current assessment and a call for resident training standards. , 2006, American journal of surgery.

[4]  Claude Ghez,et al.  Learning networks in health and Parkinson's disease: Reproducibility and treatment effects , 2003, Human brain mapping.

[5]  G. Fried,et al.  The MISTELS program to measure technical skill in laparoscopic surgery , 2006, Surgical Endoscopy And Other Interventional Techniques.

[6]  Armin Thron,et al.  Effects of long‐term practice and task complexity in musicians and nonmusicians performing simple and complex motor tasks: Implications for cortical motor organization , 2005, Human brain mapping.

[7]  R. Clayman,et al.  Advances in urological laparoscopy. , 1995, The Journal of urology.

[8]  Mitchell C. Benson,et al.  From proficiency to expert, when does the learning curve for robotic-assisted prostatectomies plateau? The Columbia University experience , 2007, World Journal of Urology.

[9]  G. Fried,et al.  Evaluating laparoscopic skills , 2003, Surgical Endoscopy And Other Interventional Techniques.

[10]  R. Shadmehr,et al.  Neural correlates of motor memory consolidation. , 1997, Science.

[11]  P. Fornara,et al.  Nonrandomized Comparison of Open Flank versus Laparoscopic Nephrectomy in 249 Patients with Benign Renal Disease , 2001, European Urology.

[12]  T. Ahlering,et al.  Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. , 2003, The Journal of urology.

[13]  Luc Proteau,et al.  Learning through observation: a combination of expert and novice models favors learning , 2011, Experimental Brain Research.

[14]  G. Fried,et al.  Relationship between objective assessment of technical skills and subjective in-training evaluations in surgical residents. , 2004, Journal of the American College of Surgeons.

[15]  S. Petersen,et al.  Changes in brain activity during motor learning measured with PET: effects of hand of performance and practice. , 1998, Journal of neurophysiology.