Utilizing transcranial direct current stimulation to enhance laparoscopic technical skills training: A randomized controlled trial

Abstract

a b s t r a c tBackground: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that delivers constant, low electrical current resulting in changes to cortical excitability. Prior work suggests it may enhance motor learning giving it the potential to augment surgical technical skill acquisition.Objectives: The aim of this study was to test the efficacy of tDCS, coupled with motor skill training, to accelerate laparoscopic skill acquisition in a pre-registered (NCT03083483), double-blind and placebocontrolled study. We hypothesized that relative to sham tDCS, active tDCS would accelerate the development of laparoscopic technical skills, as measured by the Fundamentals of Laparoscopic Surgery (FLS) Peg Transfer task quantitative metrics. Methods: In this study, sixty subjects (mean age 22.7 years with 42 females) were randomized into sham or active tDCS in either bilateral primary motor cortex (bM1) or supplementary motor area (SMA) electrode configurations. All subjects practiced the FLS Peg Transfer Task during six 20-min training blocks, which were preceded and followed by a single trial pre-test and post-test. The primary outcome was changes in laparoscopic skill performance over time, quantified by group differences in completion time from pre-test to post-test and learning curves developed from a calculated score accounting for errors. Results: Learning curves calculated over the six 20-min training blocks showed significantly greater improvement in performance for the bM1 group than the sham group (t ¼ 2.07, p ¼ 0.039), with the bM1 group achieving approximately the same amount of improvement in 4 blocks compared to the 6 blocks required of the sham group. The SMA group also showed greater mean improvement than sham, but exhibited more variable learning performance and differences relative to sham were not significant (t ¼ 0.85, p ¼ 0.400). A significant main effect was present for pre-test versus post-test times (F ¼ 133.2, p < 0.001), with lower completion times at post-test, however these did not significantly differ for the training groups. Conclusion: Laparoscopic skill training with active bilateral tDCS exhibited significantly greater learning relative to sham. The potential for tDCS to enhance the training of surgical skills, therefore, merits further investigation to determine if these preliminary results may be replicated and extended.

Prefrontal transcranial direct-current stimulation improves early technical skills in surgery

“…Compared to the hour of training here, prior studies [5e8] had limited task training prior to tDCS sessions, and it is conceivable that participants were still familiarizing themselves to the task during tDCS episodes. We aimed to carefully evaluate and control for prior task exposure, whereas others had a propensity towards more senior students receiving active stimulation [6] and use of participants not affiliated with medicine [8].…”

“…Ciechanski and colleagues [5e7] were the first to provide valuable evidence of tDCS in this context using a unilateral M1 montage and demonstrated improved neurosurgical resection metrics and pattern cutting scores, with the former being maintained over 6 weeks. Subsequently, Cox et al [8] built on this with greater gains using multiple sessions of bilateral M1 stimulation over SMA stimulation. However, It is interesting to note certain methodological preferences (e.g.…”

Systematic review of combined functional near-infrared spectroscopy and transcranial direct-current stimulation studies

“…For example, tDCS has been used to enhance performance in high cognitive load environments in the military 85,86 and surgery. 87,88 In these aforementioned applications, if fNIRS is combined with tDCS, a powerful tool could be established to elucidate the physiological impact of tDCS in the real-world settings and would be a step forward to transition the conventional neurophysiological studies from the laboratory to naturalistic environments.…”

Developing expert gaze pattern in laparoscopic surgery requires more than behavioral training

“…To test the consistency of the AOI definitions, the AOI sizes (pixel 2 ) for both AOITP and AOINO were extracted and tested between the surgeon and novice groups, resulting in non-significant differences (ps > .39). The behavioral Performance Score followed previous research (Cox et al, 2020) and was computed by accounting for both task completion time and errors. Errors included drops within the field-of-view, drops outside of the field-of-view, and improper transfers (e.g., using the wrong dissectors to move an object or resting the object on a peg during transfer), and were penalized by increased task completion time (seconds).…”