Utilizing transcranial direct current stimulation to enhance laparoscopic technical skills training: A randomized controlled trial.


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.





Published Version (Please cite this version)


Publication Info

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.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Jonathan Young

Assistant Consulting Professor in the Department of Psychiatry and Behavioral Sciences

Jonathan Robert Young, MD is Assistant Consulting Professor at Duke Department of Psychiatry & Behavioral Sciences, and Staff Psychiatrist at Durham VA Health Care System, Treatment Refractory Disorders Clinic. He is a member of the Division of Behavioral Medicine & Neurosciences where he has served as an attending physician in the Duke electroconvulsive therapy (ECT) clinic. His research interests focus on clinical applications of non-invasive neuromodulation technologies such as repetitive transcranial magnetic stimulation (rTMS) for the treatment of psychiatric and substance use disorders. Currently, Dr. Young is developing a multimodal smoking cessation intervention for Veterans with posttraumatic stress disorder (PTSD) who smoke utilizing functional-connectivity magnetic resonance imaging (fc-MRI) to guide a personalized and accelerated rTMS course in addition to cognitive behavioral therapy (CBT) and nicotine replacement therapy (NRT).


Sarah Hollingsworth Lisanby

Professor Emeritus of Psychiatry and Behavioral Sciences

Sarah Hollingsworth “Holly” Lisanby, MD, is an experienced translational researcher and innovator of neuromodulation technologies to study and treat psychiatric disorders. Dr. Lisanby is Director of the Division of Translational Research at NIMH, which funds research on the discovery of preventions, treatments, and cures for mental illness across the lifespan.  She is Founder and Director of the Noninvasive Neuromodulation Unit in the NIMH Intramural Research Program, a multi-disciplinary clinical research program specializing in the innovation of new brain stimulation tools to measure and modulate neuroplasticity to improve mental health.  Dr. Lisanby is former Chair of the Duke Department of Psychiatry & Behavioral Sciences, and JP Gibbons Endowed Professor at Duke University.  She founded and directed both the Duke and the Columbia University Divisions of Brain Stimulation, where she built interdisciplinary research programs specializing in the convergence of Psychiatry, Neuroscience and Engineering. She co-led the NIH BRAIN Initiative Team focused on large-scale neural recording and modulation devices. Dr. Lisanby has been principal investigator on a series of federally funded grants on the development of novel neuromodulation technologies, including the rational design of magnetic and electrical seizure therapies.  Her team pioneered magnetic seizure therapy (MST) as a novel depression treatment from the stages of animal testing, first-in-human, and international clinical trials.  She led a series of studies involving transcranial magnetic stimulation, electroconvulsive therapy (ECT), MST, vagus nerve stimulation, and deep brain stimulation. She has received numerous international recognitions, including the Max Hamilton Memorial Prize of the Collegium Internationale Neuro-Psychopharmacologicum, the Gerald Klerman Award from the National Depression and Manic Depression Association, and the Eva King Killam Research Award from the American College of Neuropsychopharmacology.  She has been a member of the NIMH Board of Scientific Counselors. Dr. Lisanby served on the FDA Neurological Devices Advisory Panel and has held key leadership positions with numerous professional associations, including serving as President for the Association for Convulsive Therapy/International Society of Neurostimulation, and the International Society for Transcranial Stimulation, and Chair of the American Psychiatric Association Task Force to Revise the Practice on ECT. 


John Migaly

Associate Professor of Surgery

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.