Introduction
cognitive and motor skills, FLS
EVENTS, POLAND
The acquisition of basic surgical skills is a key component of medical education for medical students and junior surgical trainees. Laparoscopic surgery is a minimally invasive surgical technique that involves the introduction of trocars and instruments through small incisions in the patient’s abdomenTrainees in laparoscopic surgery typically begin developing their skills using simulation box trainers. Simulation of basic surgical tasks provides a safe platform for surgical trainees to develop the requisite cognitive and motor skills with no risk to patient outcomes. A variety of tasks can be administered and specific programs such as the Fundamentals of Laparoscopic Surgery (FLS) have been developed and incorporated into surgical training curricula worldwideIn recent years, one technique that has shown promise as an adjunct to the deliberate practice of motor skill is transcranial electric stimulation (tES). Typically administered as a direct current (tDCS), this form of neurostimulation involves passing small electrical currents (1–3 mA) over the scalp to modulate the excitability of underlying cortical neurons for up to 60 min following stimulationOver the past 5 years, emerging research has been conducted examining the impact of tDCS on surgical skill acquisition. The few studies to date vary not only according to their methodological rigour but also by the site of neurostimulation, the tasks experimenters evaluated and the metrics that were used to quantify performance. For example, stimulation has largely been administered over the prefrontal cortexOne such system that incorporates software that can integrate with traditional simulation box trainers to provide surgical trainees with biomechanical kinematic data of the implements during simulated surgical tasks has been developed by the company, LAPARO (Laparo analytic, Laparo Medical Simulators, Poland). Since its inception in 2015, this system has now been integrated in medical settings in over 90 countries around the world in over 1000 hospitals, medical schools, and simulation centers. Despite its widespread acceptance, no study to date has assessed the effect of tDCS on laparoscopic skill acquisition incorporating performance metrics from the LAPARO software. By determining the kinematic markers of surgical skill improvement and the effect that tDCS can have on these markers across training, we can better understand how to evaluate surgical skill and coach surgical trainees.The purpose of this study was to assess the impact that tDCS may have on the training induced improvement and retention of traditional time and kinematic based laparoscopic surgical skill metrics. We hypothesised that those receiving tDCS applied over the hand regions of M1 would show greater training-mediated improvements in the time required to complete simulated surgical tasks, in the distance implements travelled over the course of the task, in the average velocity of the implements across tasks and through a reduction in the number of excessive velocity events, compared to those receiving a sham stimulation.