BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that delivers constant, low electrical current resulting in changes to cortical excitability. Prior work suggests it may enhance motor learning giving it the potential to augment surgical technical skill acquisition. OBJECTIVES The aim of this study was to test the efficacy of tDCS, coupled with motor skill training, to accelerate laparoscopic skill acquisition in a pre-registered (NCT03083483), double-blind and placebo-controlled study. We hypothesized that relative to sham tDCS, active tDCS would accelerate the development of laparoscopic technical skills, as measured by the Fundamentals of Laparoscopic Surgery (FLS) Peg Transfer task quantitative metrics. METHODS In this study, sixty subjects (mean age 22.7 years with 42 females) were randomized into sham or active tDCS in either bilateral primary motor cortex (bM1) or supplementary motor area (SMA) electrode configurations. All subjects practiced the FLS Peg Transfer Task during six 20-min training blocks, which were preceded and followed by a single trial pre-test and post-test. The primary outcome was changes in laparoscopic skill performance over time, quantified by group differences in completion time from pre-test to post-test and learning curves developed from a calculated score accounting for errors. RESULTS Learning curves calculated over the six 20-min training blocks showed significantly greater improvement in performance for the bM1 group than the sham group (t = 2.07, p = 0.039), with the bM1 group achieving approximately the same amount of improvement in 4 blocks compared to the 6 blocks required of the sham group. The SMA group also showed greater mean improvement than sham, but exhibited more variable learning performance and differences relative to sham were not significant (t = 0.85, p = 0.400). A significant main effect was present for pre-test versus post-test times (F = 133.2, p < 0.001), with lower completion times at post-test, however these did not significantly differ for the training groups. CONCLUSION Laparoscopic skill training with active bilateral tDCS exhibited significantly greater learning relative to sham. The potential for tDCS to enhance the training of surgical skills, therefore, merits further investigation to determine if these preliminary results may be replicated and extended.

中文翻译：

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利用经颅直流电刺激加强腹腔镜技术技能培训：一项随机对照试验

背景经颅直流电刺激（tDCS）是一种非侵入性脑刺激技术，它提供恒定的低电流，导致皮层兴奋性发生变化。先前的工作表明它可以增强运动学习，使其有可能增强外科技术技能的获得。目标 本研究的目的是在一项预注册 (NCT03083483)、双盲和安慰剂对照研究中测试 tDCS 与运动技能训练相结合的功效，以加速腹腔镜技能的获得。我们假设相对于假 tDCS，主动 tDCS 将加速腹腔镜技术技能的发展，正如腹腔镜手术 (FLS) 桩转移任务定量指标所衡量的那样。方法 在这项研究中，60 名受试者（平均年龄 22. 7 岁，42 名女性）随机分为双侧初级运动皮层 (bM1) 或辅助运动区 (SMA) 电极配置的假手术或主动 tDCS。所有受试者在六个 20 分钟的训练块中练习 FLS Peg Transfer Task，在此之前和之后进行一次试验前测试和后测试。主要结果是腹腔镜技能表现随时间的变化，通过从前测到后测的完成时间的组差异以及根据计算出的错误分数制定的学习曲线来量化。结果 在六个 20 分钟的训练块上计算的学习曲线显示，bM1 组的表现比假组有显着提高（t = 2.07，p = 0.039），与假手术组所需的 6 个块相比，bM1 组在 4 个块中实现了大致相同的改进量。SMA 组也显示出比假手术更大的平均改善，但表现出更多可变的学习表现，并且相对于假手术的差异不显着（t = 0.85，p = 0.400）。前测与后测时间存在显着的主效应（F = 133.2，p < 0.001），后测的完成时间较短，但这些在训练组中没有显着差异。结论 与假手术相比，采用主动双侧 tDCS 的腹腔镜技能训练表现出明显更好的学习效果。因此，tDCS 增强手术技能培训的潜力值得进一步研究，以确定这些初步结果是否可以复制和扩展。