BACKGROUND Studies applying transcranial direct-current stimulation (tDCS) to motor regions to enhance surgical skills have observed modest benefits in performance. Early surgical skills acquisition is known to be dependent on the prefrontal cortex (PFC) which could be a suitable target for performance enhancement in fields with high cognitive demand. OBJECTIVE To assess whether prefrontal tDCS could improve early phases of surgical skill development. METHODS In a randomized sham-controlled double-blind parallel design, 40 surgical novices performed an open knot-tying task repeated in three blocks; pre-, online- and post-tDCS. During online stimulation, participants were randomized to either active tDCS (2mA for 15 min) to the prefrontal cortex (anode over F3, cathode over F4) or sham tDCS. Performance score (PS) was computed using a validated algorithm and introspective workload domains were assessed using a SURG-TLX questionnaire. RESULTS There was no difference in demographics or PS between groups prior to receiving tDCS. PS significantly improved from pre-to online- (p < 0.001) and from pre-to post-tDCS (p < 0.001) in the active group only. Following active tDCS, PS was closer to the defined proficiency benchmark and significantly greater compared to sham (p = 0.002). Only the active group reported significantly improved temporal demand scores from pre-to online- (p = 0.004) to post-tDCS (p = 0.002). CONCLUSIONS This study demonstrates significantly improved early phase surgical-skill acquisition following prefrontal tDCS. Further work is required to determine the underlying neurophysiological mechanisms and whether the benefits observed are retained long-term.

中文翻译：

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脑刺激前额经颅直流电刺激的原始研究提交提高了手术的早期技术技能

背景 将经颅直流电刺激 (tDCS) 应用于运动区域以提高手术技能的研究已观察到在性能方面的适度益处。众所周知，早期手术技能的获得依赖于前额叶皮层 (PFC)，而前额叶皮层 (PFC) 可能是在具有高认知需求的领域中提高表现的合适目标。目的 评估前额叶 tDCS 是否可以改善手术技能发展的早期阶段。方法 在随机假手术控制的双盲平行设计中，40 名外科新手进行了一个开放式打结任务，分三个时间段重复进行；tDCS 之前、在线和之后。在在线刺激期间，参与者被随机分配到前额叶皮层（阳极超过 F3，阴极超过 F4）或假 tDCS 的主动 tDCS（2mA 持续 15 分钟）。使用经过验证的算法计算性能评分 (PS)，使用 SURG-TLX 问卷评估内省工作负载域。结果 在接受 tDCS 之前，各组之间的人口统计学或 PS 没有差异。仅在活动组中，PS 从前到在线（p < 0.001）和从 tDCS 前到后（p < 0.001）都有显着改善。在主动 tDCS 之后，PS 更接近于定义的熟练程度基准，并且与假手术相比明显更高（p = 0.002）。只有活跃组报告了从在线前到在线（p = 0.004）到 tDCS 后（p = 0.002）的显着改善的时间需求分数。结论 本研究表明，前额叶 tDCS 后早期手术技能获得显着改善。