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, F ( 10,1 ) = 7495.5, p < 0.01. 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 (η2 = 0.257). Two-tailed Mann–Whitney U tests with a 95% confidence interval showed baseline equivalence and a statistically significant (p < 0.001) difference in the CPFC-SMA WPCO metrics for the physical simulator training group (0.960 ± 0.045) versus the untrained control group (0.735 ± 0.177) 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.

中文翻译：

---

在物理和虚拟模拟环境中与手术技能灵巧相关的功能性大脑连接

意义：虚拟和物理手术模拟器越来越多地被用作教授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的和不一致的。目的：我们提出了从脑成像测量得出的功能激活指标，以客观地评估具有不同手术技能的受试者的脑激活与手术运动技能之间的对应关系。方法：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) 测量基于 36 名受试者氧合血红蛋白 (HbO) 变化的皮层激活，因为它们与运动相关。技能学习。区域间功能连通性指标，即 小波相干性 (WCO) 和小波相位相干性源自 HbO 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：单向多变量方差分析发现，基于 Wilk's Λ 对于专家和新手，物理模拟器的区域间 WCO 指标在统计​​上存在显着差异，F ( 10,1 ) = 7495.5，p < 0.01。发现区域间 WCO 指标的部分 eta 平方效应大小在中央前额叶皮层 (CPFC) 和 SMA 之间最高，CPFC-SMA (η2 = 0.257)。具有 95% 置信区间的双尾 Mann-Whitney U 检验表明，物理模拟器训练组 (0.960 ± 0.045) 与未训练对照组的基线等效性和 CPFC-SMA WPCO 指标的统计学显着差异 (p < 0.001) (0.735±0。177) 除了前测和后测之外，连续 10 天进行训练。结论：我们表明脑功能连接 WCO 指标对应于腹腔镜物理模拟器中的手术运动技能。CPFC 和 SMA 之间的功能连接对于展示专家手术运动技能的受试者比腹腔镜物理模拟器中未经训练的受试者要低。