Effects of Transcranial Direct-current Stimulation on Laparoscopic Surgical Skill Acquisition

Overview

Journal BJS Open

Publisher Oxford University Press

Specialty General Surgery

Date 2018 Jun 29

PMID 29951631

Citations 10

Authors

P Ciechanski

A Cheng

O Damji

S Lopushinsky

K Hecker

Z Jadavji

A Kirton

Affiliations

Soon will be listed here.

Abstract

Background: Changes in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct-current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation-based laparoscopic surgical skill acquisition.

Methods: In this double-blind, sham-controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation-based training. Primary outcomes of laparoscopic pattern-cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent-to-treat analysis examined the effects of treatment group on skill acquisition and retention.

Results: Of 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern-cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures.

Conclusion: The addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non-simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).

Citing Articles

Optical neuroimaging and neurostimulation in surgical training and assessment: A state-of-the-art review.

Goble M, Caddick V, Patel R, Modi H, Darzi A, Orihuela-Espina F Front Neuroergon. 2024; 4:1142182.

PMID: 38234498 PMC: 10790870. DOI: 10.3389/fnrgo.2023.1142182.

Anodal cerebellar t-DCS impacts skill learning and transfer on a robotic surgery training task.

Caccianiga G, Mooney R, Celnik P, Cantarero G, Brown J Sci Rep. 2023; 13(1):21394.

PMID: 38123594 PMC: 10733429. DOI: 10.1038/s41598-023-47404-1.

M1 transcranial direct current stimulation augments laparoscopic surgical skill acquisition.

Galvin D, Toth A, OReilly B, OSullivan R, Campbell M Sci Rep. 2023; 13(1):13731.

PMID: 37612337 PMC: 10447451. DOI: 10.1038/s41598-023-40440-x.

Neuroenhancement of surgeons during robotic suturing.

Patel R, Suwa Y, Kinross J, von Roon A, Woods A, Darzi A Surg Endosc. 2021; 36(7):4803-4814.

PMID: 34724587 PMC: 9160107. DOI: 10.1007/s00464-021-08823-1.

Neuroimaging Guided Transcranial Electrical Stimulation in Enhancing Surgical Skill Acquisition. Comment on Hung et al. The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of....

Walia P, Kumar K, Dutta A Brain Sci. 2021; 11(8).

PMID: 34439698 PMC: 8395024. DOI: 10.3390/brainsci11081078.

References

Ding J, Xia Y, Liao G, Zhang Z, Liu S, Zhang Y . Hand-assisted laparoscopic surgery versus open surgery for colorectal disease: a systematic review and meta-analysis. Am J Surg. 2013; 207(1):109-19. DOI: 10.1016/j.amjsurg.2013.04.013. View

Rose J, Weiser T, Hider P, Wilson L, Gruen R, Bickler S . Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health. 2015; 3 Suppl 2:S13-20. PMC: 5746187. DOI: 10.1016/S2214-109X(15)70087-2. View

Mattar S, Alseidi A, Jones D, Jeyarajah D, Swanstrom L, Aye R . General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013; 258(3):440-9. DOI: 10.1097/SLA.0b013e3182a191ca. View

Woods A, Antal A, Bikson M, Boggio P, Brunoni A, Celnik P . A technical guide to tDCS, and related non-invasive brain stimulation tools. Clin Neurophysiol. 2015; 127(2):1031-1048. PMC: 4747791. DOI: 10.1016/j.clinph.2015.11.012. View

Derossis A, Fried G, Abrahamowicz M, Sigman H, Barkun J, Meakins J . Development of a model for training and evaluation of laparoscopic skills. Am J Surg. 1998; 175(6):482-7. DOI: 10.1016/s0002-9610(98)00080-4. View

Reis J, Schambra H, Cohen L, Buch E, Fritsch B, Zarahn E . Noninvasive cortical stimulation enhances motor skill acquisition over multiple days through an effect on consolidation. Proc Natl Acad Sci U S A. 2009; 106(5):1590-5. PMC: 2635787. DOI: 10.1073/pnas.0805413106. View

Madan A, Frantzides C, Park W, Tebbit C, Kumari N, OLeary P . Predicting baseline laparoscopic surgery skills. Surg Endosc. 2004; 19(1):101-4. DOI: 10.1007/s00464-004-8123-7. View

Jamal M, Doi S, Rousseau M, Edwards M, Rao C, Barendregt J . Systematic review and meta-analysis of the effect of North American working hours restrictions on mortality and morbidity in surgical patients. Br J Surg. 2012; 99(3):336-44. DOI: 10.1002/bjs.8657. View

Goldin S, Horn G, Schnaus Jr M, Grichanik M, Ducey A, Nofsinger C . FLS skill acquisition: a comparison of blocked vs interleaved practice. J Surg Educ. 2014; 71(4):506-12. DOI: 10.1016/j.jsurg.2014.01.001. View

10.

Poulose B, Ray W, Arbogast P, Needleman J, Buerhaus P, Griffin M . Resident work hour limits and patient safety. Ann Surg. 2005; 241(6):847-56. PMC: 1357165. DOI: 10.1097/01.sla.0000164075.18748.38. View

11.

Ahmed N, Devitt K, Keshet I, Spicer J, Imrie K, Feldman L . A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg. 2014; 259(6):1041-53. PMC: 4047317. DOI: 10.1097/SLA.0000000000000595. View

12.

von Rein E, Hoff M, Kaminski E, Sehm B, Steele C, Villringer A . Improving motor performance without training: the effect of combining mirror visual feedback with transcranial direct current stimulation. J Neurophysiol. 2015; 113(7):2383-9. PMC: 4416593. DOI: 10.1152/jn.00832.2014. View

13.

Fritsch B, Reis J, Martinowich K, Schambra H, Ji Y, Cohen L . Direct current stimulation promotes BDNF-dependent synaptic plasticity: potential implications for motor learning. Neuron. 2010; 66(2):198-204. PMC: 2864780. DOI: 10.1016/j.neuron.2010.03.035. View

14.

Dayan E, Censor N, Buch E, Sandrini M, Cohen L . Noninvasive brain stimulation: from physiology to network dynamics and back. Nat Neurosci. 2013; 16(7):838-44. PMC: 4876726. DOI: 10.1038/nn.3422. View

15.

BINDMAN L, Lippold O, REDFEARN J . Long-lasting changes in the level of the electrical activity of the cerebral cortex produced bypolarizing currents. Nature. 1962; 196:584-5. DOI: 10.1038/196584a0. View

16.

Bonrath E, Weber B, Fritz M, Mees S, Wolters H, Senninger N . Laparoscopic simulation training: Testing for skill acquisition and retention. Surgery. 2012; 152(1):12-20. DOI: 10.1016/j.surg.2011.12.036. View

17.

Bikson M, Grossman P, Thomas C, Zannou A, Jiang J, Adnan T . Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul. 2016; 9(5):641-661. PMC: 5007190. DOI: 10.1016/j.brs.2016.06.004. View

18.

Gomes-Osman J, Field-Fote E . Bihemispheric anodal corticomotor stimulation using transcranial direct current stimulation improves bimanual typing task performance. J Mot Behav. 2013; 45(4):361-7. DOI: 10.1080/00222895.2013.808604. View

19.

TIFFIN J, ASHER E . The Purdue pegboard; norms and studies of reliability and validity. J Appl Psychol. 1948; 32(3):234-47. DOI: 10.1037/h0061266. View

20.

Nitsche M, Paulus W . Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000; 527 Pt 3:633-9. PMC: 2270099. DOI: 10.1111/j.1469-7793.2000.t01-1-00633.x. View