背景:由于新技术的出现,手术技能的获取正在不断发展,并且需要评估工具与这些工具一起开发。在外科医生获得新颖的手术技能的同时,已经使用了一系列神经成像方式来绘制脑网络的功能激活图。这些已被提出作为一种方法,以提供对外科专业知识的更深入理解,并为未来外科医生的个性化培训提供新的可能性。由于研究的模式不同,结果,和手术技巧需要对证据进行系统的审查。本系统综述旨在总结当前有关该主题的知识,并评估神经影像学在外科教育中的潜在用途。
方法:我们对神经影像学研究进行了系统评价,这些研究绘制了脑功能激活图,同时具有不同专业知识水平的外科医生学习并执行技术和非技术手术任务。我们纳入了7月1日之前发表的所有研究,2023年,在MEDLINE,基地和科学网络。
结果:确定了38项基于任务的大脑映射研究,由随机对照试验组成,病例对照研究,以及观察性队列或横断面研究。这些研究采用了广泛的大脑绘图模式,包括脑电图,功能磁共振成像,正电子发射断层扫描,和功能近红外光谱,激活涉及执行和感觉运动或手术技能认知控制的大脑区域,尤其是前额叶皮层,辅助电机区域,和初级电机区,显示新手和专家之间的重大变化。
结论:功能神经成像可以揭示与任务相关的大脑活动如何反映技术和非技术手术技能。现有的工作体系强调了神经影像学将任务相关的大脑活动模式与个人能力水平或训练手术技能后的表现提高联系起来的潜力。需要更多的研究来确定其作为评估工具的有效性和有用性。
BACKGROUND: Surgical skills acquisition is under continuous development due to the emergence of new technologies, and there is a need for assessment tools to develop along with these. A range of neuroimaging modalities has been used to map the functional activation of brain networks while surgeons acquire novel surgical skills. These have been proposed as a method to provide a deeper understanding of surgical expertise and offer new possibilities for the personalized training of future surgeons. With studies differing in modalities, outcomes, and surgical skills there is a need for a systematic
review of the evidence. This systematic
review aims to summarize the current knowledge on the topic and evaluate the potential use of neuroimaging in surgical education.
METHODS: We conducted a systematic
review of neuroimaging studies that mapped functional brain activation while surgeons with different levels of expertise learned and performed technical and non-technical surgical tasks. We included all studies published before July 1st, 2023, in MEDLINE, EMBASE and WEB OF SCIENCE.
RESULTS: 38 task-based brain mapping studies were identified, consisting of randomized controlled trials, case-control studies, and observational cohort or cross-sectional studies. The studies employed a wide range of brain mapping modalities, including electroencephalography, functional magnetic resonance imaging, positron emission tomography, and functional near-infrared spectroscopy, activating brain areas involved in the execution and sensorimotor or cognitive control of surgical skills, especially the prefrontal cortex, supplementary motor area, and primary motor area, showing significant changes between novices and experts.
CONCLUSIONS: Functional neuroimaging can reveal how task-related brain activity reflects technical and non-technical surgical skills. The existing body of work highlights the potential of neuroimaging to link task-related brain activity patterns with the individual level of competency or improvement in performance after training surgical skills. More research is needed to establish its validity and usefulness as an assessment tool.