Directed information flow during laparoscopic surgical skill acquisition dissociated skill level and medical simulation technology

Abstract

The comparison of the effects of physical and virtual reality (VR) simulators on the brain network during skill acquisition has not been well addressed. In this study, the brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) data from seven experienced right-handed surgeons and six right-handed medical students during the performance of a well-established Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks. Multiple regression path analysis found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F(2, 114) = 9, p < 0.001, and R2 = 0.136. The coefficient of variation (CoV) of the FLS performance score was statistically significantly related to the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F(2, 22) = 3.912, p = 0.035, and R2 = 0.262. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F(1,15) = 6.002, p = 0.027; partial η2 = 0.286). This involvement of the right prefrontal cortex is potentially related to the uncertainty that underpins FLS task performance based on skill level and medical simulator technology.