The frontal cortex is activated during learning of endoscopic procedures.
BACKGROUND
To date, several training and evaluation systems for endoscopic surgery have been developed, such as virtual-reality simulators and box trainers. However, despite current advances in these objective assessments, no functional brain studies during learning of endoscopic surgical skills have been carried out. In the present study, we investigated cortical activation using near-infrared spectroscopy (NIRS) during endoscopic surgical tasks.


METHODS
A total of 21 right-handed subjects, comprising 4 surgical experts, 4 trainees, and 13 novices, participated in the study. Suturing and knot-tying tasks were performed in a box trainer. Cortical activation was assessed in all subjects by task-related changes in hemoglobin (Hb) oxygenation using NIRS.


RESULTS
In surgical experts and novices with no experience of endoscopic surgical training, we found no changes in oxy-Hb, deoxy-Hb or total-Hb levels in any of the frontal channels. In surgical trainees and one novice with experience of endoscopic surgical training, we found significant increases in oxy-Hb and total-Hb levels in most of the frontal channels. There were significant differences in oxy-Hb and total-Hb levels in CH-19 between surgical experts and trainees (p = 0.02 for both), and between surgical trainees and novices with no experience of endoscopic surgical training (p = 0.008 for both). Furthermore, additional training increased oxy-Hb levels in the frontal cortex of novices with no experience of endoscopic surgical training but had no such effect on surgical experts.


CONCLUSIONS
The present data suggest that NIRS is a feasible tool for assessing brain activation during endoscopic surgical tasks, and may have a large impact on the future development of teaching, training, and assessment methods for endoscopic surgical skills.
Ohuchida
Kenoki
K
Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
Kenmotsu
Hajime
H
Yamamoto
Atsuyuki
A
Sawada
Kazuya
K
Hayami
Takehito
T
Morooka
Kenichi
K
Takasugi
Shinichiro
S
Konishi
Kozo
K
Ieiri
Satoshi
S
Tanoue
Kazuo
K
Iwamoto
Yukihide
Y
Tanaka
Masao
M
Hashizume
Makoto
M
D002983:Clinical Competence; D004724:Endoscopy / Q000193:education*; D005625:Frontal Lobe / Q000378:metabolism*; D006801:Humans; D010108:Oxyhemoglobins / Q000378:metabolism*; D019265:Spectroscopy, Near-Infrared; D018709:Statistics, Nonparametric; D013536:Suture Techniques
D010108:Oxyhemoglobins