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

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. Concluslon: 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.