Correlation of laparoscopic experience with differential functional brain activation: A positron emission tomography study with oxygen 15-labeled water

Hypothesis: Regions of functional brain activation differ between novice and expert laparoscopists. Design: We compared novice and expert laparoscopists using positron emission tomography (PET) during the peg transfer task of the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) protocol. The first scan (rest) was performed with the subject's eyes closed. The second scan (video 1) was performed while watching a peg transfer video. The third scan (peg 1) was acquired during the peg transfer task. The forth scan (peg 2) was performed after practicing 15 minutes. The fifth scan (video 2) was performed after peg 2 as the subject watched a video clip of a laparoscopic partial nephrectomy. The sixth scan (peg 3) was conducted during the final peg transfer task after 15 more minutes of practice. Setting: Feinstein Institute for Medical Research. Participants: Five novice and 5 expert laparoscopists. Main Outcome Measures: Differences in brain activation as determined by changes in regional cerebral blood flow on PET scans with oxygen 15-labeled water. Results: The first analysis examined group differences between the 3 peg scans and the rest scan. The novice group had a significantly (P<.001) higher activation (with deactivation in the expert group) in the left precentral gyrus and insula and the right precuneus and inferior occipital gyrus. The second analysis compared the 2 video scans and the rest scan. In contrast to the expert group, the novices had significantly (P<.001) higher activation in the right precuneus and cuneus but deactivation in the bilateral posterior cerebellum. Conclusions: This study demonstrates differential regional brain activation patterns between novice and expert laparoscopists during surgery-related motor and visual association tasks.