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Research Letter |

Persistent Prefrontal Engagement Despite Improvements in Laparoscopic Technical Skill

Kunal Shetty, MRCS1; Daniel Richard Leff, FRCS, MS, PhD1; Felipe Orihuela-Espina, PhD1; Guang-Zhong Yang, PhD, FREng1; Ara Darzi, FRCS, FRS1
[+] Author Affiliations
1Hamlyn Centre for Robotic Surgery, Imperial College London, London, England
JAMA Surg. 2016;151(7):682-684. doi:10.1001/jamasurg.2016.0050.
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This study examines prefrontal responses of surgeons of varying experience levels during a suturing drill to evaluate laparoscopic surgery skills.

Teaching and assessment of laparoscopic skills are currently essential components of surgical training. The Fundamentals of Laparoscopic Surgery (FLS) is a widely adopted training program based on expert-derived benchmarks; technical skills are assessed and completion is a mandatory criterion for general surgery board certification in the United States.1 However, is attainment of technical proficiency synonymous with being a safe surgeon? Intraoperative errors persist and are thought to be related to errors in cognition2 as opposed to technical failure per se. The prefrontal cortex (PFC) is a brain region associated with attention and executive function serving as a scaffold to support novel task demands during effortful unrefined performance.3 Studies examining cortical correlates of technical skills acquisition have observed predictable attenuation in PFC response alongside improvement in technical performance4,5; however, this has not been adequately tested for challenging laparoscopic skills.

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Figure.
A Participant’s Brain Activity Monitored During Performance of Laparoscopic Surgical Task

The image illustrates the experimental set-up of a participant performing laparoscopic suturing and knot tying. Prefrontal cortex activity was recorded by a 44-channel optical topographic system. Emitters (red) and detectors (blue) detect cortical activity when placed over a region of interest.

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