How is your surgeon doing?

By Meryem A. Yücel

Imagine a device that we could put on a surgeon’s head to provide insights into his performance in a surgery based on brain activity. Variability in performance might be affected by the surgeon’s emotional/cognitive state, prior surgical experience, and motor skills? Such a technique would enable surgical skill assessments in two critical areas: during training and certification.  Wouldn’t that be nice?
No, there is no magical device like that yet, but Dr. Xavier Intes and Dr. Suvranu De together with their team at RPI are eagerly pursuing just such a goal.

The current approach to board certification of technical skills of general surgeons is performed based on the Fundamentals of Laparoscopic Surgery (FLS) program. Performance scoring is based on time taken and errors made. As with many such tests, some subjectivity is introduced into the scoring by the proctors who administer the FLS exam. Non-invasive neuroimaging technology has the potential to make the certification process more objective.
Using functional near-infrared spectroscopy, the researchers measured activity in trained surgeons’ and medical students’ prefrontal , primary and supplementary motor cortical areas. They found that brain activity as measured by fNIRS allowed classification into groups with various surgical skill levels and with high sensitivity and specificity (Nemani et al., Science Advances). Based on performance by a different cohort, the researchers were also able to show that changes in patterns of brain activity reflected progression in training over the course of 11 days. They point out that unskilled medical students show greater prefrontal activity as they strategize to learn the FLS tasks, while higher motor cortex activity is observed in skilled surgeons while executing a learned sequence of tasks.
Dr. Xavier Intes and Dr. Suvranu De point out that their goal is not to replace FLS altogether but complement it with brain-based measurements. They postulate that brain-based imaging techniques could lead to an effective approach to tailoring personalized surgical training and skill assessment in surgeons.

Schematic depiction of the experimental setup. Reprinted with permission of AAAS from [Nemani et al., Sci. Adv. 2018; 4 : eaat3807]. © The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC) http://creativecommons.org/licenses/by-nc/4.0/

To know more:

Arun Nemani, Meryem A. Yücel, Uwe Kruger, Denise W. Gee, Clairice Cooper, Steven D. Schwaitzberg, Suvranu De and Xavier Intes “Assessing bimanual motor skills with optical neuroimaging” Science Advances 4(10):eaat3807 DOI: 10.1126/sciadv.aat3807