Brain activation during laparoscopic tasks in high- and low-performing medical students: a pilot fMRI study

  • Alaina Garbens
  • Bonnie A. Armstrong
  • Marisa Louridas
  • Fred Tam
  • Allan S. Detsky
  • Tom A. Schweizer
  • Simon J. Graham
  • Teodor GrantcharovEmail author



Up to 20% of medical students are unable to reach competency in laparoscopic surgery. It is unknown whether these difficulties arise from heterogeneity in neurological functioning across individuals. We sought to examine the differences in neurological functioning during laparoscopic tasks between high- and low-performing medical students using functional magnetic resonance imaging (fMRI).


This prospective cohort study enrolled North American medical students who were within the top 20% and bottom 20% of laparoscopic performers from a previous study. Brain activation was recorded using fMRI while participants performed peg-pointing, intracorporeal knot tying (IKT), and the Pictorial Surface Orientation (PicSOr) test. Brain activation maps were created and areas of activation were compared between groups.


In total, 9/12 high and 9/13 low performers completed the study. High performers completed IKT faster and made more successful knot ties than low performers [standing: 23.5 (5.0) sec vs. 37.6 (18.4) sec, p = 0.03; supine: 23.2 (2.5) sec vs. 72.7 (62.8) sec, p = 0.02; number of successful ties supine, 3 ties vs. 1 tie, p = 0.01]. Low performers showed more brain activation than high performers in the peg-pointing task (q < 0.01), with no activation differences in the IKT task. There were no behavioral differences in the PiCSOr task.


This study is the first to show differences between low and high performers of laparoscopic tasks at the brain level. This pilot study has shown the feasibility of using fMRI to examine laparoscopic surgical skills. Future studies are needed for further exploration of our initial findings.


Surgical training Neural activity Technical performance Laparoscopic simulation 



We the authors have no funding to acknowledge.

Compliance with ethical standards


Teodor Grantcharov is an equity holder in Surgical Safety Technologies Inc. Alaina Garbens, Bonnie Armstrong, Marisa Louridas, Fred Tam, Allan Detsky, Tom A. Schweizer, and Simon Graham have no conflicts of interest or financial ties to disclose.

Supplementary material

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Supplementary material 1 (DOCX 79 kb)
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Supplementary material 2 (DOCX 76 kb)
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Supplementary material 3 (DOCX 84 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  2. 2.International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St Michael’s HospitalTorontoCanada
  3. 3.Physical Sciences Platform, Sunnybrook Research Institute, TorontoTorontoCanada
  4. 4.Institute for Health Policy Management and Evaluation and Department of MedicineUniversity of TorontoTorontoCanada
  5. 5.Mount Sinai Hospital and University Health NetworkTorontoCanada
  6. 6.Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  7. 7.Division of Neurosurgery, Department of Surgery, Faculty of MedicineUniversity of TorontoTorontoCanada
  8. 8.Institute of Biomaterials and Biomedical Engineering, University of TorontoTorontoCanada
  9. 9.Department of Medical Biophysics, Faculty of MedicineUniversity of TorontoTorontoCanada

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