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

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Title: Prefrontal transcranial direct-current stimulation improves early technical skills in surgery
Authors: Ashcroft, J
Patel, R
Woods, A
Darzi, A
Singh, H
Leff, D
Item Type: Journal Article
Abstract: Background Studies applying transcranial direct-current stimulation (tDCS) to motor regions to enhance surgical skills have observed modest benefits in performance. Early surgical skills acquisition is known to be dependent on the prefrontal cortex (PFC) which could be a suitable target for performance enhancement in fields with high cognitive demand. Objective To assess whether prefrontal tDCS could improve early phases of surgical skill development. Methods In a randomized sham-controlled double-blind parallel design, 40 surgical novices performed an open knot-tying task repeated in three blocks; pre-, online- and post-tDCS. During online stimulation, participants were randomized to either active tDCS (2 mA for 15 min) to the prefrontal cortex (anode over F3, cathode over F4) or sham tDCS. Performance score (PS) was computed using a validated algorithm and introspective workload domains were assessed using a SURG-TLX questionnaire. Results There was no difference in demographics or PS between groups prior to receiving tDCS. PS significantly improved from pre-to online- (p < 0.001) and from pre-to post-tDCS (p < 0.001) in the active group only. Following active tDCS, PS was closer to the defined proficiency benchmark and significantly greater compared to sham (p = 0.002). Only the active group reported significantly improved temporal demand scores from pre-to online- (p = 0.004) to post-tDCS (p = 0.002). Conclusions This study demonstrates significantly improved early phase surgical-skill acquisition following prefrontal tDCS. Further work is required to determine the underlying neurophysiological mechanisms and whether the benefits observed are retained long-term.
Issue Date: 1-Nov-2020
Date of Acceptance: 22-Oct-2020
URI: http://hdl.handle.net/10044/1/84990
DOI: 10.1016/j.brs.2020.10.013
ISSN: 1876-4754
Publisher: Elsevier
Start Page: 1834
End Page: 1841
Journal / Book Title: Brain Stimulation
Volume: 13
Issue: 6
Copyright Statement: ©2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Sponsor/Funder: National Institute of Health Research
Keywords: Motor skills
Operative surgical procedures
Prefrontal cortex
Psychomotor performance
Transcranial direct-current stimulation
Neurology & Neurosurgery
11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2020-10-31
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation



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