Neuroenhancement in surgeons: benefits, risks and ethical dilemmas

Abstract

Background Surgeons traditionally aim to reduce mistakes in healthcare through repeated training and advancement of surgical technology. Recently, performance‐enhancing interventions such as neurostimulation are emerging which may offset errors in surgical practice. Methods Use of transcranial direct‐current stimulation (tDCS), a novel neuroenhancement technique that has been applied to surgeons to improve surgical technical performance, was reviewed. Evidence supporting tDCS improvements in motor and cognitive performance outside of the field of surgery was assessed and correlated with emerging research investigating tDCS in the surgical setting and potential applications to wider aspects of healthcare. Ethical considerations and future implications of using tDCS in surgical training and perioperatively are also discussed. Results Outside of surgery, tDCS studies demonstrate improved motor performance with regards to reaction time, task completion, strength and fatigue, while also suggesting enhanced cognitive function through multitasking, vigilance and attention assessments. In surgery, current research has demonstrated improved performance in open knot‐tying, laparoscopic and robotic skills while also offsetting subjective temporal demands. However, a number of ethical issues arise from the potential application of tDCS in surgery in the form of safety, coercion, distributive justice and fairness, all of which must be considered prior to implementation. Conclusion Neuroenhancement may improve motor and cognitive skills in healthcare professions with impact on patient safety. Implementation will require accurate protocols and regulations to balance benefits with the associated ethical dilemmas, and to direct safe use for clinicians and patients.

Decreasing the Surgical Errors by Neurostimulation of Primary Motor Cortex and the Associated Brain Activation via Neuroimaging

“…These results indicate the merit of the application of tDCS to increase performance accuracy in fine motor skill learning. The benefit, risks, and ethical dilemmas have been discussed in a recent review paper (Patel et al, 2020).…”

“…Furthermore, the learning procedure for complex skills is usually time and resource-consuming. Here, to the best of our knowledge, we are the first to investigate the effect of tES on the learning procedure of a complex surgical motor task (Patel et al, 2020), which typically takes more than 10 days to achieve proficiency (Gao et al, 2020c).…”

Neuroenhancement of surgeons during robotic suturing

“…For novel training adjuncts, such as tDCS, there still remains a clear need for further research before any benefits in surgical skill enhancement are validated. However, should advantages of its use be established in the future, it is interesting to consider how a technology such as tDCS could be incorporated into surgical training alongside the potential ethical implications of doing so [ 66 ]. Safety would be the first priority and consistent with existing tDCS literature, including reports from over 30,000 stimulation sessions [ 67 ], no serious adverse effects were reported in this study.…”

The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials

“…Electronic searches with the keyword of (deep transcranial magnetic stimulation OR dTMS OR repetitive transcranial magnetic stimulation OR rTMS OR TMS OR non-invasive brain stimulation OR theta burst stimulation OR transcranial direct current stimulation OR TBS OR tDCS OR vagus nerve stimulation OR vagal nerve stimulation OR tVNS OR nVNS OR VNS OR static magnetic field stimulation) AND (skill OR professionalism OR skill acquisition) AND (surgery OR surgical OR surgeon) AND (random OR randomized OR randomised) in the PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov platforms through 19 April 2021 had been conducted (the detailed search strategy is provided in Table S2). Furthermore, to expand the pool of potential studies, we consulted the reference lists of review articles and performed further manual searches [27][28][29]. No language restriction had been applied.…”