Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

P Ciechanski, A Cheng, O Damji, S Lopushinsky, K Hecker, Z Jadavji, A Kirton, P Ciechanski, A Cheng, O Damji, S Lopushinsky, K Hecker, Z Jadavji, A Kirton

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/).

Figures

Figure 1
Figure 1
a Trial design. Participants performed the Purdue Pegboard Test (PPT) and one repetition of the peg transfer and pattern‐cutting Fundamental of Laparoscopic Surgery tasks. b Stimulation montage. The anode was positioned over the dominant primary motor cortex (M1), and the cathode over the contralateral supraorbital area
Figure 2
Figure 2
a Learning curve for Fundamentals of Laparscopic Surgery pattern cutting concurrent with sham or anodal transcranial direct‐current stimulation (tDCS). Values are mean(s.e.m.). b Proportion of participants achieving various levels of pattern‐cutting proficiency at post‐training evaluation with the application of sham stimulation or anodal tDCS. *P = 0·022 (t test)
Figure 3
Figure 3
a Learning curve of Fundamentals of Laparoscopic Surgery peg transfer concurrent with sham or anodal transcranial direct‐current stimulation (tDCS). Values are mean(s.e.m.). b Proportion of participants achieving various levels of peg transfer proficiency at post‐training evaluation with the application of sham stimulation or anodal tDCS

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