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Patel R, Ashcroft J, Darzi A, Singh H, Leff DR. Neuroenhancement in surgeons: benefits, risks and ethical dilemmas. Br J Surg 2020; 107:946-950. [DOI: 10.1002/bjs.11601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Surgeons traditionally aim to reduce mistakes in healthcare through repeated training and advancement of surgical technology. Recently, performance-enhancing interventions such as neurostimulation are emerging which may offset errors in surgical practice.
Methods
Use of transcranial direct-current stimulation (tDCS), a novel neuroenhancement technique that has been applied to surgeons to improve surgical technical performance, was reviewed. Evidence supporting tDCS improvements in motor and cognitive performance outside of the field of surgery was assessed and correlated with emerging research investigating tDCS in the surgical setting and potential applications to wider aspects of healthcare. Ethical considerations and future implications of using tDCS in surgical training and perioperatively are also discussed.
Results
Outside of surgery, tDCS studies demonstrate improved motor performance with regards to reaction time, task completion, strength and fatigue, while also suggesting enhanced cognitive function through multitasking, vigilance and attention assessments. In surgery, current research has demonstrated improved performance in open knot-tying, laparoscopic and robotic skills while also offsetting subjective temporal demands. However, a number of ethical issues arise from the potential application of tDCS in surgery in the form of safety, coercion, distributive justice and fairness, all of which must be considered prior to implementation.
Conclusion
Neuroenhancement may improve motor and cognitive skills in healthcare professions with impact on patient safety. Implementation will require accurate protocols and regulations to balance benefits with the associated ethical dilemmas, and to direct safe use for clinicians and patients.
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Affiliation(s)
- R Patel
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - J Ashcroft
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - A Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - H Singh
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - D R Leff
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
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The role of the posterior parietal cortex in stereopsis and hand-eye coordination during motor task behaviours. Cogn Process 2014; 16:177-90. [PMID: 25394882 DOI: 10.1007/s10339-014-0641-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
The field of 'Neuroergonomics' has the potential to improve safety in high-risk operative environments through a better appreciation of the way in which the brain responds during human-tool interactions. This is especially relevant to minimally invasive surgery (MIS). Amongst the many challenges imposed on the surgeon by traditional MIS (laparoscopy), arguably the greatest is the loss of depth perception. Robotic MIS platforms, on the other hand, provide the surgeon with a magnified three-dimensional view of the environment, and as a result may offload a degree of the cognitive burden. The posterior parietal cortex (PPC) plays an integral role in human depth perception. Therefore, it can be hypothesized that differences in PPC activation between monoscopic and stereoscopic vision may be observed. In order to investigate this hypothesis, the current study explores disparities in PPC responses between monoscopic and stereoscopic visual perception to better de-couple the burden imposed by laparoscopy and robotic surgery on the operator's brain. Fourteen participants conducted tasks of depth perception and hand-eye coordination under both monoscopic and stereoscopic visual feedback. Cortical haemodynamic responses were monitored throughout using optical functional neuroimaging. Overall, recruitment of the bilateral superior parietal lobule was observed during both depth perception and hand-eye coordination tasks. This occurred contrary to our hypothesis, regardless of the mode of visual feedback. Operator technical performance was significantly different in two- and three-dimensional visual displays. These differences in technical performance do not appear to be explained by significant differences in parietal lobe processing.
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Visuo-spatial ability and fMRI cortical activation in surgery residents. Am J Surg 2008; 195:138. [PMID: 18070738 DOI: 10.1016/j.amjsurg.2007.05.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 05/01/2007] [Accepted: 05/04/2007] [Indexed: 11/21/2022]
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Koh PH, Glaser DE, Flandin G, Kiebel S, Butterworth B, Maki A, Delpy DT, Elwell CE. Functional optical signal analysis: a software tool for near-infrared spectroscopy data processing incorporating statistical parametric mapping. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:064010. [PMID: 18163826 DOI: 10.1117/1.2804092] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Optical topography (OT) relies on the near infrared spectroscopy (NIRS) technique to provide noninvasively a spatial map of functional brain activity. OT has advantages over conventional fMRI in terms of its simple approach to measuring the hemodynamic response, its ability to distinguish between changes in oxy- and deoxy-hemoglobin and the range of human participants that can be readily investigated. We offer a new software tool, functional optical signal analysis (fOSA), for analyzing the spatially resolved optical signals that provides statistical inference capabilities about the distribution of brain activity in space and time and by experimental condition. It does this by mapping the signal into a standard functional neuroimaging analysis software, statistical parametric mapping (SPM), and forms, in effect, a new SPM toolbox specifically designed for NIRS in an OT configuration. The validity of the program has been tested using synthetic data, and its applicability is demonstrated with experimental data.
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Affiliation(s)
- Peck H Koh
- University College London, Department of Medical Physics and Bioengineering, Biomedical Optics Research Laboratory, Gower Street, London WC1E 6BT United Kingdom. pkoha.medphys.ucl.ac.uk
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Leff DR, Orihuela-Espina F, Atallah L, Darzi A, Yang GZ. Functional near infrared spectroscopy in novice and expert surgeons--a manifold embedding approach. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2007; 10:270-7. [PMID: 18044578 DOI: 10.1007/978-3-540-75759-7_33] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Monitoring expertise development in surgery is likely to benefit from evaluations of cortical brain function. Brain behaviour is dynamic and nonlinear. The aim of this paper is to evaluate the application of a nonlinear dimensionality reduction technique to enhance visualisation of multidimensional functional Near Infrared Spectroscopy (fNIRS) data. Manifold embedding is applied to prefrontal haemodynamic signals obtained during a surgical knot tying task from a group of 62 healthy subjects with varying surgical expertise. The proposed method makes no assumption about the functionality of the data set and is shown to be capable of recovering the intrinsic low dimensional structure of in vivo brain data. After manifold embedding, Earth Mover's Distance (EMD) is used to quantify different patterns of cortical behaviour associated with surgical expertise and analyse the degree of inter-hemispheric channel pair symmetry.
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Affiliation(s)
- Daniel Richard Leff
- Royal Society/Wolfson Medical Image Computing Laboratory, Department of Biosurgery and Surgical Technology, Imperial College London, United Kingdom.
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