TABLE 1. Selected studies Author Imaging modality Paradigm Task Sample size Groups studied Neuroimaging findings Performance Stress Leff et al (2006)20 fNIRS Feasibility study Open surgical knot tying 7 Trainees (n=3), novices (n=4) Left PFC and left M1 activated in all subjects T>N Leff et al (2007)4 fNIRS Technical skills Open surgical knot tying 62 Experts (n=19), trainees (n=21), novices (n=22) PFC activation: N>T, T=E PFC activation predominantly L sided in novices E=T, T>N Leff et al (2008)5 fNIRS Technical skills Laparoscopic localisation task 14 Novices Attenuation of PFC activation with skills training Leff et al (2008)6 fNIRS Technical skills Open surgical knot tying 19 Novices Attenuation of PFC activation with skills training Performance improved after training Leff et al (2008)7 fNIRS Technical skills Open surgical knot tying 62 Experts (n=19), trainees (n=21), novices (n=22) Stable PFC activation in E & T groups over 5 trials Attenuation of PFC activation in N group over 5 trials Stable performance in E & T groups over 5 trials Improved performance in N group over 5 trials Ohuchida et al (2009)13 fNIRS Technical skills Laparoscopic knot tying 21 Experts (n=4), trainees (n=4), novices (n=13) PFC activation on initial task performance: N=E, T>E PFC activation 2 hours training session: N>E E>T, T>N Ros et al (2009)30 EEG Neurofeedback Simulated cataract operation 20 Trainee ophthalmologists Improvements in suture score, time on task and overall technique with SMR-T neurofeedback training No significant improvements in performance with AT Reduced STAI scores with neurofeedback training No significant change in STAI scores with AT
Duty et al (2012)15 PET Technical skills Laparoscopic peg transfer task & observation of laparoscopic tasks 10 Experts (n=5), novices (n=5) Peg transfer task: Novices: activation in L precentral gyrus, L insula, R precuneus gyrus and R inferior occipital gyrus. Experts: deactivation in all four of these regions Task observation: Novices: activation in R precuneus gyrus and R cuneus; deactivation in bilateral posterior cerebellum. Experts: deactivation in R precuneus gyrus and R cuneus; activation in posterior cerebellum Overall experts performed better than novices Novice performance improved from 1st to 2nd peg transfer tasks Mylonas et al (2012)36 fNIRS Robot-assisted technology Tracking deforming tissue (free hand motor control or GCMC) 21 Novices Greater PFC activation with GCMC than with free hand control Better performance observed in the GCMC group James et al (2013)35 fNIRS Robot-assisted technology Visuo-motor tracking task (free hand motor control or GCMC) 21 Novices The GCMC group had more rapid attenuation in PFC activity and more rapid focusing of PPC activity FP networks in the GCMC group were more economic, efficient and small worldly Better performance observed in the GCMC group Bocci et al (2013)33 EEG Robot-assisted technology Laparoscopic & robotic suturing 16 Trained surgeons Increased intra-hemispheric coherence in laparoscopic suturing in theta and lower alpha bands Increased inter-hemispheric coherence in robotic suturing in upper alpha and beta bands Bahrami et al (2014)21 fMRI Feasibility study FLS tasks 9 Novices Increasing task complexity resulted in activation of motor and sensory areas, and Performance worsened as task complexity increased