Neuroenhancement of future surgeons – Opinions from students, surgeons and patients

Patel, Ronak; Rai, Amar; Thornton-Wood, Frank; Wilkinson, Aimee; Darzi, Ara; Singh, Harsimrat; Leff, Daniel

doi:10.1016/j.brs.2021.03.012

Cited by 2 publications

(4 citation statements)

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“…It would be of utmost importance that trainees retain full autonomy on using tDCS, whilst also being approved by higher regulatory bodies. However, early qualitative data [ 69 ] suggests a general acceptance for its use, should safety and efficacy be assured.…”

Section: Discussionmentioning

confidence: 99%

Neuroenhancement of surgeons during robotic suturing

et al. 2021

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Background The initial phases of robotic surgical skills acquisition are associated with poor technical performance, such as low knot-tensile strength (KTS). Transcranial direct-current stimulation (tDCS) can improve force and accuracy in motor tasks but research in surgery is limited to open and laparoscopic tasks in students. More recently, robotic surgery has gained traction and is now the most common approach for certain procedures (e.g. prostatectomy). Early-phase robotic suturing performance is dependent on prefrontal cortex (PFC) activation, and this study aimed to determine whether performance can be improved with prefrontal tDCS. Methods Fifteen surgical residents were randomized to either active then sham tDCS or sham then active tDCS, in two counterbalanced sessions in a double-blind crossover study. Within each session, participants performed a robotic suturing task repeated in three blocks: pre-, intra- and post-tDCS. During the intra-tDCS block, participants were randomized to either active tDCS (2 mA for 15 min) to the PFC or sham tDCS. Primary outcome measures of technical quality included KTS and error scores. Results Significantly faster completion times were observed longitudinally, regardless of active (p < 0.001) or sham stimulation (p < 0.001). KTS was greater following active compared to sham stimulation (median: active = 44.35 N vs. sham = 27.12 N, p < 0.001). A significant reduction in error scores from “pre-” to “post-” (p = 0.029) were only observed in the active group. Conclusion tDCS could reduce error and enhance KTS during robotic suturing and warrants further exploration as an adjunct to robotic surgical training.

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Section: Discussionmentioning

confidence: 99%

Neuroenhancement of surgeons during robotic suturing

et al. 2021

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“…Direct visualization of cognitive processes which occur during training opens the possibility of targeting these processes with direct cognitive stimulation. Neurostimulation may optimize cognitive responses to surgical training, improving the quality and speed of skill acquisition (Dissanayaka et al, 2017 ; Biabani et al, 2018 ; Ciechanski et al, 2018 ; Patel et al, 2019 , 2021 ; Hung et al, 2021 ). Transcranial direct-current stimulation (tDCS) is a safe, non-invasive neurostimulation technique (Paulus, 2011 ) which sustains low-amplitude current (typically < 2 mA) through the brain and modulates neuronal excitability and plasticity.…”

Section: Neurostimulationmentioning

confidence: 99%

“…Its intensity is too low to generate neuronal excitability de-novo (Paulus, 2011 ; Morya et al, 2019 ). Improvement in motor task performance is conferred safely through tDCS (Bikson et al, 2016 ; Patel et al, 2019 , 2021 ; Gao et al, 2021a ; Hung et al, 2021 ) along with the prevention of stress induced working memory impairment, which suggests new applications for neuroenhancement (Bogdanov and Schwabe, 2016 ). Further clarification is still needed regarding the types of skill neurostimulation interventions may enhance as there may be some task-dependent effect on the strength of improvement of learning; in other words, certain tasks may be more improved than others through the use of tDCS.…”

Section: Neurostimulationmentioning

confidence: 99%

“…Other factors must also be taken into consideration, such as the opinions of trainees and patients. Whilst data suggests they are supportive of neuroenhancement (Patel et al, 2021 ), trainees may be reluctant to devote time, money, and effort to new technologies before there is a strong evidence base to prove that these interventions improve outcomes.…”

Section: Neurostimulationmentioning

confidence: 99%

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

Goble

Caddick

Patel

et al. 2023

Front. Neuroergonomics

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IntroductionFunctional near-infrared spectroscopy (fNIRS) is a non-invasive optical neuroimaging technique used to assess surgeons' brain function. The aim of this narrative review is to outline the effect of expertise, stress, surgical technology, and neurostimulation on surgeons' neural activation patterns, and highlight key progress areas required in surgical neuroergonomics to modulate training and performance.MethodsA literature search of PubMed and Embase was conducted to identify neuroimaging studies using fNIRS and neurostimulation in surgeons performing simulated tasks.ResultsNovice surgeons exhibit greater haemodynamic responses across the pre-frontal cortex than experts during simple surgical tasks, whilst expert surgical performance is characterized by relative prefrontal attenuation and upregulation of activation foci across other regions such as the supplementary motor area. The association between PFC activation and mental workload follows an inverted-U shaped curve, activation increasing then attenuating past a critical inflection point at which demands outstrip cognitive capacity Neuroimages are sensitive to the impact of laparoscopic and robotic tools on cognitive workload, helping inform the development of training programs which target neural learning curves. FNIRS differs in comparison to current tools to assess proficiency by depicting a cognitive state during surgery, enabling the development of cognitive benchmarks of expertise. Finally, neurostimulation using transcranial direct-current-stimulation may accelerate skill acquisition and enhance technical performance.ConclusionFNIRS can inform the development of surgical training programs which modulate stress responses, cognitive learning curves, and motor skill performance. Improved data processing with machine learning offers the possibility of live feedback regarding surgeons' cognitive states during operative procedures.

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Neuroenhancement of future surgeons – Opinions from students, surgeons and patients

Cited by 2 publications

References 9 publications

Neuroenhancement of surgeons during robotic suturing

Neuroenhancement of surgeons during robotic suturing

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

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