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Brain activation during laparoscopic tasks in high- and low-performing medical students: a pilot fMRI study

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Abstract

Background

Up to 20% of medical students are unable to reach competency in laparoscopic surgery. It is unknown whether these difficulties arise from heterogeneity in neurological functioning across individuals. We sought to examine the differences in neurological functioning during laparoscopic tasks between high- and low-performing medical students using functional magnetic resonance imaging (fMRI).

Methods

This prospective cohort study enrolled North American medical students who were within the top 20% and bottom 20% of laparoscopic performers from a previous study. Brain activation was recorded using fMRI while participants performed peg-pointing, intracorporeal knot tying (IKT), and the Pictorial Surface Orientation (PicSOr) test. Brain activation maps were created and areas of activation were compared between groups.

Results

In total, 9/12 high and 9/13 low performers completed the study. High performers completed IKT faster and made more successful knot ties than low performers [standing: 23.5 (5.0) sec vs. 37.6 (18.4) sec, p = 0.03; supine: 23.2 (2.5) sec vs. 72.7 (62.8) sec, p = 0.02; number of successful ties supine, 3 ties vs. 1 tie, p = 0.01]. Low performers showed more brain activation than high performers in the peg-pointing task (q < 0.01), with no activation differences in the IKT task. There were no behavioral differences in the PiCSOr task.

Conclusions

This study is the first to show differences between low and high performers of laparoscopic tasks at the brain level. This pilot study has shown the feasibility of using fMRI to examine laparoscopic surgical skills. Future studies are needed for further exploration of our initial findings.

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Funding

We the authors have no funding to acknowledge.

Author information

Authors and Affiliations

  1. Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Alaina Garbens, Marisa Louridas & Teodor Grantcharov

  2. International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada

    Bonnie A. Armstrong

  3. Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Toronto, ON, Canada

    Fred Tam & Simon J. Graham

  4. Institute for Health Policy Management and Evaluation and Department of Medicine, University of Toronto, Toronto, ON, Canada

    Allan S. Detsky

  5. Mount Sinai Hospital and University Health Network, Toronto, ON, Canada

    Allan S. Detsky

  6. Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Tom A. Schweizer

  7. Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Tom A. Schweizer

  8. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada

    Tom A. Schweizer

  9. Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Simon J. Graham

Authors
  1. Alaina Garbens
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  2. Bonnie A. Armstrong
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  3. Marisa Louridas
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  4. Fred Tam
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  6. Tom A. Schweizer
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  8. Teodor Grantcharov
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Corresponding author

Correspondence to Teodor Grantcharov.

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Disclosures

Teodor Grantcharov is an equity holder in Surgical Safety Technologies Inc. Alaina Garbens, Bonnie Armstrong, Marisa Louridas, Fred Tam, Allan Detsky, Tom A. Schweizer, and Simon Graham have no conflicts of interest or financial ties to disclose.

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Garbens, A., Armstrong, B.A., Louridas, M. et al. Brain activation during laparoscopic tasks in high- and low-performing medical students: a pilot fMRI study. Surg Endosc 34, 4837–4845 (2020). https://doi.org/10.1007/s00464-019-07260-5

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  • DOI: https://doi.org/10.1007/s00464-019-07260-5

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