Utilizing transcranial direct current stimulation to enhance laparoscopic technical skills training: A randomized controlled trial.
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2020-05
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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.
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Cox, Morgan L, Zhi-De Deng, Hannah Palmer, Amanda Watts, Lysianne Beynel, Jonathan R Young, Sarah H Lisanby, John Migaly, et al. (2020). Utilizing transcranial direct current stimulation to enhance laparoscopic technical skills training: A randomized controlled trial. Brain stimulation, 13(3). pp. 863–872. 10.1016/j.brs.2020.03.009 Retrieved from https://hdl.handle.net/10161/20718.
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Jonathan Young
Jonathan Robert Young, MD is a Medical Assistant Professor in the Duke Department of Psychiatry & Behavioral Sciences and a Staff Psychiatrist at the Durham VA Health Care System. His clinical and research work centers on advancing evidence-based treatments for treatment-resistant psychiatric conditions and substance use disorders, with a particular focus on noninvasive neuromodulation. Dr. Young’s research integrates repetitive transcranial magnetic stimulation (rTMS) with neuroimaging and computational targeting approaches to improve precision, optimize dosing, and clarify mechanisms of action. A major area of emphasis is tobacco and nicotine use disorder, especially among high-risk populations such as veterans with posttraumatic stress disorder (PTSD).
He also contributes to the neuroethics and policy dimensions of brain stimulation, examining ethical, equity, and implementation considerations that shape responsible clinical translation. Dr. Young is co-editor of the Springer volume TMS and Neuroethics, which highlights emerging ethical and societal issues in neuromodulation research and clinical practice. Through Duke’s Bass Connections program, he leads interdisciplinary efforts that integrate artificial intelligence with evidence synthesis, including the development of WikiStim.org—an AI-enhanced, searchable repository of peer-reviewed neuromodulation studies designed to support meta-analysis, knowledge translation, and data-driven clinical decision-making. His broader goal is to build scalable, ethically grounded, technology-enabled frameworks that improve access, rigor, and real-world impact of neuromodulation-based care.
Sarah Hollingsworth Lisanby
Sarah “Holly” Hollingsworth Lisanby, MD, is the Founding Dean of the Arizona State University John Shufeldt School of Medicine and Medical Engineering. Dr. Lisanby has a track record of visionary senior leadership in academic medicine and the federal government. An internationally renowned innovator of neuromodulation technologies, Dr. Lisanby is Professor Emeritus at Duke University and is currently Director of the Division of Translational Research at the National Institute of Mental Health (NIMH), where she is responsible for managing a portfolio of approximately $400 Million to support research directed towards the discovery of preventions, treatments, and cures for mental illness across the lifespan. She co-led the NIH BRAIN Initiative Team focused on large-scale neural recording and modulation devices. Immediately prior to being recruited to NIH, Dr. Lisanby held the JP Gibbons Endowed Professorship with Tenure at Duke University and was the first woman to be selected as Chair of the Duke University Department of Psychiatry and Behavioral Sciences, a large, research-focused department which employs approximately 800 individuals, including approximately 400 faculty and 400 staff, and spanning the Duke-affiliated Durham VA Medical Center and Duke-affiliated Central Regional State Psychiatric Hospital. In this senior academic leadership role at a top 10 medical school, Dr. Lisanby successfully identified opportunities for synergy across disparate research programs, built consensus across stakeholders, tackled complex operational challenges, and rallied support for major structural changes, as illustrated in numerous new programs that launched under her tenure including: i) a new Autism Center with a translational program that integrates clinical care with research and education; ii) a new Division on Addictions Research and Treatment, spanning translational research programs in animal models of the mechanisms of addiction and advances in device-assisted ecologically valid data collection and behavioral intervention; iii) an integrated pediatric mental health program, spanning psychiatry, neurology and pediatrics; and iv) a new program in Global Mental Health. Dr. Lisanby’s effectiveness in forging partnerships with the Health System is demonstrated by the fact that, under her leadership, Psychiatry became the fastest growing clinical department at Duke. In 5 years under her leadership, the cumulative annual growth rate for patient revenue was over 20% (more than 4 times higher than other departments) and clinical productivity increased by over 200%. She enabled this expansion by successfully implementing an integrative care model that embedded mental health care into primary care clinics.
Dr. Lisanby led an active research lab in the NIMH Intramural Research Program, where she founded and directed the NIMH Noninvasive Neuromodulation Unit (NNU). The NNU is a pioneering clinical translational research lab specializing in the development of innovative brain stimulation tools to measure and modulate neuroplasticity to improve mental health. An accomplished clinical translational scientist, Dr. Lisanby is internationally known for her pioneering research leading to the FDA approval of novel devices for the treatment of depression, including transcranial magnetic stimulation (TMS). Continuously NIH-funded for over 20 years, Dr. Lisanby’s research translates knowledge of neurocircuitry underlying brain-based disorders into circuit-targeted therapeutics, informed by mechanisms of treatment resistant neuropsychiatric disorders. Dr. Lisanby’s key accomplishments include pioneering magnetic seizure therapy (MST) as a rapidly acting antidepressant, from the stages of device development, preclinical testing, first-in-human trials, and multi-center trials, leading up to the pivotal noninferiority trial against gold-standard treatment currently underway to support FDA approval. She founded and directed both the Duke University and the Columbia University Divisions of Brain Stimulation, where she built interdisciplinary research programs specializing in the convergence of Psychiatry, Neuroscience and Engineering. She has been principal investigator on a series of NIH and DARPA funded studies on the development of novel neuromodulation technologies, including studies on the rational design of magnetic and electrical seizure therapies. A prolific author with over 330 publications, Dr. Lisanby was recognized by the Web of Science as a 2020 recipient of the most highly cited researchers in the Cross-Field category.
Dr. Lisanby has received numerous national and international awards, including the Distinguished Investigator Award from the National Alliance for Research on Schizophrenia and Depression (NARSAD, now called the Brain Behavior Research Foundation), the Max Hamilton Memorial Prize of the Collegium Internationale Neuro-Psychopharmacologicum (CINP), the Gerald Klerman Award from the National Depression and Manic Depression Association (NDMDA), and the Eva King Killam Research Award from the American College of Neuropsychopharmacology (ACNP). Dr. Lisanby was elected as a member and Councilor of the Association of American Physicians, and as a Fellow of the ACNP. Dr. Lisanby serves on the FDA Neurological Devices Advisory Panel and has held key senior leadership positions in professional organizations including serving as President of the International Society for ECT and Neurostimulation and Chair of the APA Task Force to Revise the Practice on Electroconvulsive Therapy (ECT). Dr. Lisanby serves on numerous high level national and international scientific advisory boards including: the Scientific Advisory Board for the Aalto University School of Science, Netherlands; the Scientific Advisory Board of the Coordination and Support Action for BrainHealth (an EU-funded European Partnership); the Scientific Council of the Brain Behavior Research Foundation; the Scientific Advisory Board of the German Center for Brain Stimulation, a research consortium funded by the German Ministry for Education and Research; and the Scientific Advisory Committee of the Burroughs Wellcome Fund (BWF) Career Awards for Medical Scientists (CAMS). Prior to her recruitment to NIH, Dr. Lisanby served on the NIMH Board of Scientific Counselors. A Board-Certified Psychiatrist and Distinguished Life Fellow of the American Psychiatric Association (DLFAPA), Dr. Lisanby received her dual BS degrees in Mathematics and Psychology and her MD at Duke University.
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