Associations Between Binocular Depth Perception and Performance Gains in Laparoscopic Skill Acquisition

The ability to perceive differences in depth is important in many daily life situations. It is also of relevance in laparoscopic surgical procedures that require the extrapolation of three-dimensional visual information from two-dimensional planar images. Besides visual-motor coordination, laparoscopic skills and binocular depth perception are demanding visual tasks for which learning is important. This study explored potential relations between binocular depth perception and individual variations in performance gains during laparoscopic skill acquisition in medical students naïve of such procedures. Individual differences in perceptual learning of binocular depth discrimination when performing a random dot stereogram (RDS) task were measured as variations in the slope changes of the logistic disparity psychometric curves from the first to the last blocks of the experiment. The results showed that not only did the individuals differ in their depth discrimination; the extent with which this performance changed across blocks also differed substantially between individuals. Of note, individual differences in perceptual learning of depth discrimination are associated with performance gains from laparoscopic skill training, both with respect to movement speed and an efficiency score that considered both speed and precision. These results indicate that learning-related benefits for enhancing demanding visual processes are, in part, shared between these two tasks. Future studies that include a broader selection of task-varying monocular and binocular cues as well as visual-motor coordination are needed to further investigate potential mechanistic relations between depth perceptual learning and laparoscopic skill acquisition. A deeper understanding of these mechanisms would be important for applied research that aims at designing behavioral interventions for enhancing technology-assisted laparoscopic skills.

Role of Virtual Training Lab in Enhancing Laparoscopic Skills of Residents Versus Consultants

Objective: To compare the role of virtual training lab in enhancing laparoscopic skills at training stage and at the level of qualified surgeons. Materials and Methods: In this comparative study, we included 70 participants of national and resident MIS workshops were included, 35 consultants and 35 residents were included. Participants were analyzed in the basic laparoscopic skills of instrument navigation on Lapsim. Data were collected on first day and on last day of workshop. Parameters included were left instrument time, right instrument time, tissue damage and maximum damage. Result: In 35 residents the left instrument time was improved mean of 27.99(Range 39.52-13.43) to 21.53 (Range 42.37-12.38) and right instrument time improved mean of 31.73(Range 52-48.19) to 23.365 (Range 48.19-11.46). The tissue damage decreased from mean of 3.2 to mean of 1.46. The maximum damage decreased from mean of 8.82 to mean of 3.408. Data of consultants showed that the left instrument time improved mean of 35.71 (Range 140.22-13.09) to 24.39 (Range 111.82-9.71) and right instrument time improved mean of 45.76 (Range 141.45-15.89) to 27.82 (Range 49.2-8.6). The tissue damage decreases from mean of 5.171 to mean of 2.228. The maximum damage decrease from mean of 13.67 to mean of 5.136. All the values at consultant level were greater than resident level. Conclusion: This study further confirmed that virtual lab has very important role in improving laparoscopic skills and in addition this study prove that enhancing of the laparoscopic skill at resident level is much better than the acquisition of laparoscopic skill at consultant level. Keywords: Virtual Training Lab, Laparoscopy, Simulation.

Dynamic causal modeling for EEG during complex laparoscopic skill acquisition

Fundamentals of Laparoscopic Surgery (FLS) is a prerequisite for board certification in general surgery in the USA. It includes a motor skills portion with five psychomotor tasks of increasing task complexity: (i) pegboard transfers, (ii) pattern cutting, (iii) placement of a ligating loop, (iv) suturing with extracorporeal knot tying, and (v) suturing with intracorporal knot tying. Learning these tasks typically relies on extensive practice [1]. Nemani et al. [2] showed that the wavelet coherence based functional connectivity from functional near-infrared spectroscopy (fNIRS) data between the medial prefrontal cortex and the supplementary motor area (SMA) was lower for experts than novices during FLS pattern cutting task. Here, SMA is known for the plasticity of interhemispheric connectivity involving sensorimotor network [3] relevant in learning bimanual laparoscopic tasks; however, transcranial direct current (tDCS) of SMA resulted in more variability during FLS pegboard transfers than bilateral primary motor cortex tDCS. Here, it is essential to differentiate tDCS effects on the pre-SMA from SMA proper in the SMA complex during laparoscopic skill acquisition due to differences in their fiber tracts [4] and their relevance to motor task complexity. Prior work using fNIRS-based activation during most complex FLS suturing task with intracorporeal knot tying [5] showed the involvement of premotor/frontal module [4] related Brodmann areas (BA), shown in Figure 1c, including ventrolateral PFC (VLPFC; BA: 44, 45, 47), frontopolar (FP; BA: 10), dorsolateral PFC (DLPFC; BA: 9, 46) as well as a part of the orbitofrontal cortex (OFC; BA: 11) on the lateral brain surface in addition to SMA complex. However, the effective connectivity of this cognitive-motor control network was not investigated based on dynamic causal modeling (DCM) [6], where the temporal resolution of electroencephalogram (EEG) can capture fast interactions expected via short frontal lobe connections [4]. Therefore, our research aimed to identify hidden brain networks during FLS suturing with intracorporeal knot tying skill acquisition using DCM of EEG.

Learning curve of surgical novices using the single-port platform SymphonX: minimizing OR trauma to only one 15-mm incision

Background Minimally invasive single-port surgery is always associated with large incisions up to 2–3 cm, complicated handling due to the lack of triangulation, and instrument crossing. The aim of this prospective study was to report how medical students without any laparoscopic experience perform several laparoscopic tasks (rope pass, paper cut, peg transfer, recapping, and needle threading) with the new SymphonX single-port platform and to examine the learning curves in comparison to the laparoscopic multi-port technique. Methods A set of 5 laparoscopic skill tests (Rope Pass, Paper cut, Peg Transfer, Recapping, Needle Thread) were performed with 3 repetitions. Medical students performed all tests with both standard laparoscopic instruments and the new platform. Time and errors were recorded. Results A total of 114 medical students (61 females) with a median age of 23 years completed the study. All subjects were able to perform the skill tests with both standard laparoscopic multi-port and the single-port laparoscopic system and were able to significantly improve their performance over the three trials for all five tasks—rope pass (p < 0.001), paper cut (p < 0.001), peg transfer (p < 0.001), needle threading (p < 0.001), and recapping (p < 0.001). In 3 out of 5 tasks, medical students performed the tasks faster using the standard multi-port system—rope pass (p < 0.001), paper cut (p < 0.001), and peg transfer (p < 0.001). In the task recapping, medical students performed the task faster using the new single-port system (p = 0.003). In the task needle threading, there was no significant difference between the standard multi-port system and the new single-port system (p > 0.05). Conclusion This is the first study analyzing learning curves of the commercially available SymphonX platform for abdominal laparoscopic surgery when used by novices. The learning curve and the error rate are promising.

Utilizing Transcranial Direct Current Stimulation to Enhance Laparoscopic Technical Skills Training: A Randomized Controlled Trial

This study aimed to test the efficacy of transcranial direct current stimulation (tDCS) during laparoscopic skill training to determine if it has the capacity to accelerate technical skill acquisition. tDCS is a non-invasive brain stimulation technique that delivers constant, low electrical current resulting in changes to cortical excitability and prior work suggests it may enhance motor learning. We evaluate for the first time the potential of tDCS, coupled with motor skill training, to accelerate the development of laparoscopic technical skills. In this pre-registered, double-blinded and sham-controlled study, 60 healthy subjects were randomized into sham or active tDCS in either bilateral primary motor cortex (bM1) or supplementary motor area (SMA) electrode configurations. All subjects practiced the Fundamental of Laparoscopic Surgery Peg Transfer Task during a pre-test, six 20-minute training sessions, and a post-test. The primary outcome was change in laparoscopic skill performance over time, quantified by improvement in performance according to a seconds-per-object calculated score accounting for errors. Sixty participants were randomized equally into the three training cohorts (active bM1, active SMA, sham). The active groups had significantly greater improvement in performance from pre-test to post-test compared to the sham groups (108 vs 76 seconds, p = 0.018). Both bM1 and SMA active cohorts had significantly greater improvement in learning (p < 0.01), achieving the same skill level in 4 sessions compared to the 6 sessions required of the sham cohort. The SMA cohort had more variability in performance compared to the bM1 and control cohorts. Laparoscopic skill training with active, bM1 or SMA, tDCS exhibited significantly greater learning relative to training with sham tDCS. The potential for tDCS to enhance the training of surgical skills merits further investigation to determine if these preliminary results may be replicated.