Neuroimaging guided tES to facilitate complex laparoscopic surgical tasks – insights from functional near-infrared spectroscopy

Pushpinder Walia,Steven D Schwaitzberg,Xavier Intes,Suvranu De,Lora Cavuoto,Yaoyu Fu,Anirban Dutta

doi:10.1109/embc46164.2021.9631005

Pushpinder Walia, Steven D Schwaitzberg + Show 5 more

Open Access

https://doi.org/10.1109/embc46164.2021.9631005

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Abstract

Fundamentals of Laparoscopic Surgery (FLS) is a prerequisite for board certification in general surgery in the USA. In FLS, the suturing task with intracorporeal knot tying is considered the most complex task. Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (PFC) has been shown to facilitate FLS surgical skill acquisition where 2mA tDCS for 15min with the anode over F3 (10/10 EEG montage) and cathode over F4 has improved performance score in an open knot-tying task. Since PFC has a functional organization related to the hierarchy of cognitive control, we performed functional near-infrared spectroscopy (fNIRS) to investigate PFC sub-domain activation during a more complex FLS suturing task with intracorporeal knot tying. We performed fNIRS-based analysis using AtlasViewer software on two expert surgeons and four novice medical students. We found an average cortical activation mainly at the left frontopolar PFC across the experts, while the average cortical activation across the novices was primarily at the left pars opercularis of the inferior frontal gyrus and ventral premotor cortex, inferior parietal lobule, and supramarginal gyrus. Here, the average cortical activation across the novices included not only the cognitive control related brain regions but also motor control complexity related brain regions. Therefore, we present a computational pipeline to identify a 4x1 high-definition (HD) tDCS montage of motor complexity related PFC sub-regions using ROAST software.Clinical Relevance—A computational pipeline for fNIRS-guided tES to individualize electrode montage that may facilitate FLS surgical training in our future studies.

Highlights

Method ArticleIn Fundamentals of Laparoscopic Surgery (FLS), the suturing task with intracorporeal knot tying is considered the most complex
The Fundamentals of Laparoscopic Surgery (FLS) is a prerequisite for board certification in general surgery in the USA
We present a portable neuroimaging guided Transcranial direct current stimulation (tDCS) approach to monitor and facilitate subject-specific prefrontal cortex (PFC) activation during FLS task performance that is postulated to be more effective in facilitating surgical-skill acquisition than the “one-size-fits-all” approach

Summary

Method Article

In FLS, the suturing task with intracorporeal knot tying is considered the most complex. Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (PFC) has been shown to facilitate FLS surgical skill acquisition where 2mA tDCS for 15min with the anode over F3 (10/10 EEG montage) and cathode over F4 has improved performance score in an open knot-tying task. Since PFC has a functional organization related to the hierarchy of cognitive control, we performed functional near-infrared spectroscopy (fNIRS) to investigate PFC activation during the more complex FLS suturing task with intracorporeal knot tying. We performed fNIRS-based analysis using AtlasViewer software on two expert surgeons and four novice medical students. We investigated the feasibility to stimulate motor complexity related PFC regions using ROAST software and identified a 4x1 high-definition (HD) tDCS montage. Clinical Relevance—This shows the feasibility of fNIRSguided tES to individualize electrode montage that may facilitate FLS surgical training in our future studies

INTRODUCTION

Case Series

Neuroimaging-guided transcranial electrical stimulation

RESULTS

DISCUSSION

CONCLUSION