The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials.

Chao-Ming Hung,Che-Sheng Chu,Chih-Wei Hsu,Yen-Wen Chen,Cheuk-Kwan Sun,Yi-Cheng Wu,Bing-Yan Zeng,Tien-Yu Chen,Ming-Kung Wu,Bing-Syuan Zeng,Kuan-Pin Su,Ping-Tao Tseng,Yu-Shian Cheng,Pao-Yen Lin,Chih-Sung Liang

doi:10.3390/brainsci11060707

Abstract

The application of transcranial direct current stimulation (tDCS) to targeted cortices has been found to improve in skill acquisition; however, these beneficial effects remained unclear in fine and complicated skill. The aim of the current meta-analysis was to investigate the association between tDCS application and the efficacy of surgical performance during surgical skill training. We included randomized controlled trials (RCTs) investigating the efficacy of tDCS in enhancing surgical skill acquisition. This meta-analysis was conducted under a random-effect model. Six RCTs with 198 participants were included. The main result revealed that tDCS was associated with significantly better improvement in surgical performance than the sham control (Hedges’ g = 0.659, 95% confidence intervals (95%CIs) = 0.383 to 0.935, p < 0.001). The subgroups of tDCS over the bilateral prefrontal cortex (Hedges’ g = 0.900, 95%CIs = 0.419 to 1.382, p < 0.001) and the primary motor cortex (Hedges’ g = 0.599, 95%CIs = 0.245 to 0.953, p = 0.001) were both associated with significantly better improvements in surgical performance. The tDCS application was not associated with significant differences in error scores or rates of local discomfort compared with a sham control. This meta-analysis supported the rationale for the tDCS application in surgical training programs to improve surgical skill acquisition.

Highlights

At least 321 million surgical procedures were performed to treat human diseases in 2010 [1]
Among six eligible articles that provided datasets on changes in surgical performance [9,10,21,22,37,38], the main result of the meta-analysis revealed that transcranial direct current stimulation (tDCS) was associated with significantly better improvement in surgical performance than the sham control (k = 6, Hedges’ g = 0.659, 95%confidence interval (CI) = 0.383 to 0.935, p < 0.001) (Figure 2A), without significant heterogeneity (Q value = 4.808, df = 5, p = 0.440; I2 < 0.001%) but with significant publication bias via inspection of the funnel plot (Figure S1)
The subgroup of meeting abstract (k = 1, Hedges’ g = 0.982, 95% confidence intervals (95%CIs) = 0.242 to 1.721, p = 0.009) and subgroup of formally published articles (k = 5, Hedges’ g = 0.607, 95%CIs = 0.310 to 0.904, p < 0.001) both showed similar results, indicating that tDCS was associated with significantly better improvement in surgical performance than the sham control (Figure S3)

Summary

Introduction

At least 321 million surgical procedures were performed to treat human diseases in 2010 [1]. Advanced surgical skill acquisition requires high-intensity training programs and high workloads [2]. Such extreme high-intensity workloads could result in an increased risk of error, which can contribute to serious morbidity and mortality in patients [3,4]. A previous meta-analysis demonstrated no benefit in duty-hour restrictions in the improvement of safety or reductions in morbidity/mortality of patients receiving surgical procedures; the accommodation of resident training needs has been recommended [6]. Simulation-based task training had the advantage of being low risk and effective in helping trainees attain surgical skills [8]. It is important to identify an alternative to enhance the efficacy of simulation-based task training

Methods

Results

Discussion

Conclusion