Ciechanski P, Cheng A, Damji O, Lopushinsky S, Hecker K, Jadavji Z, Kirton A
Department of Neuroscience University of Calgary Calgary Alberta Canada.
Department of Pediatrics University of Calgary Calgary Alberta Canada.
BJS Open. 2018 Mar 13;2(2):70-78. doi: 10.1002/bjs5.43. eCollection 2018 Apr.
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.
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.
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.
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/).
医学教育的变革可能会限制实习生熟练掌握手术技能的机会。经颅直流电刺激（tDCS）可以增强运动技能学习，可能会提高手术操作技能的习得。本研究的目的是确定tDCS对基于模拟的腹腔镜手术技能习得的影响。
在这项双盲、假刺激对照的随机试验中，参与者被随机分配接受20分钟的阳极tDCS或在优势初级运动皮层进行假刺激，同时进行基于腹腔镜手术基础的模拟训练。腹腔镜图案切割和钉转移任务的主要结果在基线、1小时内重复操作期间以及6周时再次进行评分。意向性分析检查了治疗组对技能习得和保留的影响。
40名参与者中，接受tDCS的参与者最终图案切割平均（标准差）得分高于假刺激组（分别为207.6（30.0）和186.0（32.7）；P = 0.022）。6周时得分未变。对钉转移得分的影响无显著差异（tDCS组为210.2（23.5），假刺激组为201.7（18.1）；P = 0.111）；tDCS达到预定熟练水平的比例高于假刺激。手术耐受性良好，无严重不良事件，运动指标无下降。
在腹腔镜手术训练中添加tDCS可能会提高技能习得。需要对其他技能进行试验并转化为非模拟操作，以确定其在医学教育中的潜在价值以及对患者结局的影响。注册号：NCT02756052（https://clinicaltrials.gov/）
