DOI: 10.1093/bjs/znad258.615 ISSN:

1192 Optical Neuroimaging and Neurostimulation in Surgical Training & Assessment: A State-of-the-Art Review

M Goble, V Caddick, R Patel, H Modi, F Orihuela-Espina, D Leff
  • Surgery



Understanding surgeons’ cognitive patterns may improve surgical training and patient outcomes. Functional near-infrared spectrometry (fNIRS) is a non-invasive optical neuroimaging method increasingly used in surgical training measuring cerebral cortical blood flow using the principle of neurovascular coupling. This review outlines the effect of expertise and stress on surgeons’ neural activation patterns and highlight key progress areas required in surgical neuroergonomics to modulate training and performance.


A literature search of PubMed and Embase was conducted to identify neuroimaging studies using fNIRS in surgeons. This data formed a narrative review.


Novices exhibit greater activation of the pre-frontal cortex than experts when performing simple tasks. Decreased pre-frontal activation correlates with a decline in performance in response to stress; an understanding of neural pathways paves the way for interception of stress upstream of the subsequent deterioration of performance. Trends in fNIRS include measurement of systemic (e.g. heart rate) and regional (e.g. scalp perfusion) physiology to account for confounding factors in cerebral blood flow. FNIRS may be more accurate than current metrics in being able to reliably distinguish levels of expertise between trainees and provide a picture of global cognitive state during surgery which could lead to the development of cognitive benchmarks of expertise. Advances in machine learning facilitating improved data processing will aid bedside fNIRS use, offering the possibility of live feedback on the surgeon’s cognitive state during training or operating.


fNIRS is a burgeoning technology with multiple applications to surgical training with the potential to improve operative outcomes.

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