{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T02:44:58Z","timestamp":1767494698018,"version":"3.37.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T00:00:00Z","timestamp":1610582400000},"content-version":"vor","delay-in-days":263,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013342","name":"NIHR Imperial Biomedical Research Centre","doi-asserted-by":"publisher","award":["1215-20013"],"award-info":[{"award-number":["1215-20013"]}],"id":[{"id":"10.13039\/501100013342","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.11601","type":"journal-article","created":{"date-parts":[[2020,4,26]],"date-time":"2020-04-26T16:14:46Z","timestamp":1587917686000},"page":"946-950","source":"Crossref","is-referenced-by-count":11,"title":["Neuroenhancement in surgeons: benefits, risks and ethical dilemmas"],"prefix":"10.1093","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2386-0102","authenticated-orcid":false,"given":"R","family":"Patel","sequence":"first","affiliation":[{"name":"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"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2964-5032","authenticated-orcid":false,"given":"J","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Darzi","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Singh","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5310-1046","authenticated-orcid":false,"given":"D R","family":"Leff","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,4,26]]},"reference":[{"volume-title":"Committee on Emerging Surgical Technology and Education","author":"American College of Surgeons","key":"2022100812515258100_bjs11601-bib-0001"},{"volume-title":"Future of Surgery","year":"2018","author":"Royal College of Surgeons","key":"2022100812515258100_bjs11601-bib-0002"},{"key":"2022100812515258100_bjs11601-bib-0003","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1097\/SLA.0b013e31815fa42e","article-title":"Could variations in technical skills acquisition in surgery be explained by differences in cortical plasticity?","volume":"247","author":"Leff","year":"2008","journal-title":"Ann Surg"},{"key":"2022100812515258100_bjs11601-bib-0004","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1001\/jamasurg.2016.0050","article-title":"Persistent prefrontal engagement despite improvements in laparoscopic technical skill","volume":"151","author":"Shetty","year":"2016","journal-title":"JAMA Surg"},{"key":"2022100812515258100_bjs11601-bib-0005","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.neuroimage.2007.09.032","article-title":"Changes in prefrontal cortical behaviour depend upon familiarity on a bimanual co-ordination task: an fNIRS study","volume":"39","author":"Leff","year":"2008","journal-title":"Neuroimage"},{"key":"2022100812515258100_bjs11601-bib-0006","first-page":"270","article-title":"Functional near infrared spectroscopy in novice and expert surgeons \u2013 manifold embedding approach","volume":"10","author":"Leff","year":"2007","journal-title":"Med Image Comput Comput Assist Interv"},{"key":"2022100812515258100_bjs11601-bib-0007","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/11812715_18","volume-title":"Medical Imaging and Augmented Reality","author":"Leff","year":"2006"},{"key":"2022100812515258100_bjs11601-bib-0008","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1007\/s10439-018-2049-z","article-title":"Robotic surgery improves technical performance and enhances prefrontal activation during high temporal demand","volume":"46","author":"Singh","year":"2018","journal-title":"Ann Biomed Eng"},{"key":"2022100812515258100_bjs11601-bib-0009","doi-asserted-by":"crossref","first-page":"eaat3807","DOI":"10.1126\/sciadv.aat3807","article-title":"Assessing bimanual motor skills with optical neuroimaging","volume":"4","author":"Nemani","year":"2018","journal-title":"Sci Adv"},{"key":"2022100812515258100_bjs11601-bib-0010","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.surg.2017.05.021","article-title":"A decade of imaging surgeons' brain function (part I): terminology, techniques, and clinical translation","volume":"162","author":"Modi","year":"2017","journal-title":"Surgery"},{"key":"2022100812515258100_bjs11601-bib-0011","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2019.2552","article-title":"Association of residents' neural signatures with stress resilience during surgery","volume":"154","author":"Modi","year":"2019","journal-title":"JAMA Surg"},{"key":"2022100812515258100_bjs11601-bib-0012","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1097\/SLA.0000000000002289","article-title":"Temporal stress in the operating room: brain engagement promotes \u2018coping\u2019 and disengagement prompts \u2018choking\u2019","volume":"267","author":"Modi","year":"2018","journal-title":"Ann Surg"},{"key":"2022100812515258100_bjs11601-bib-0013","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ynstr.2015.12.006","article-title":"Stress potentiates decision biases: a stress induced deliberation-to-intuition (SIDI) model","volume":"3","author":"Yu","year":"2016","journal-title":"Neurobiol Stress"},{"key":"2022100812515258100_bjs11601-bib-0014","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.brs.2016.04.006","article-title":"A systematic review and meta-analysis of the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex in healthy and neuropsychiatric samples: influence of stimulation parameters","volume":"9","author":"Dedoncker","year":"2016","journal-title":"Brain Stimul"},{"key":"2022100812515258100_bjs11601-bib-0015","doi-asserted-by":"crossref","first-page":"20","DOI":"10.2478\/s13380-013-0104-7","article-title":"Using transcranial electrical stimulation to enhance cognitive functions in the typical and atypical brain","volume":"4","author":"Kadosh","year":"2013","journal-title":"Transl Neurosci"},{"key":"2022100812515258100_bjs11601-bib-0016","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1136\/bjsports-2012-091658","article-title":"Brain stimulation modulates the autonomic nervous system, rating of perceived exertion and performance during maximal exercise","volume":"49","author":"Okano","year":"2015","journal-title":"Br J Sports Med"},{"key":"2022100812515258100_bjs11601-bib-0017","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.3389\/fnins.2019.01213","article-title":"The impact of transcranial direct current stimulation on upper-limb motor performance in healthy adults: a systematic review and meta-analysis","volume":"13","author":"Patel","year":"2019","journal-title":"Front Neurosci"},{"key":"2022100812515258100_bjs11601-bib-0018","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1002\/bjs5.43","article-title":"Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition: a randomized clinical trial","volume":"2","author":"Ciechanski","year":"2018","journal-title":"BJS Open"},{"key":"2022100812515258100_bjs11601-bib-0019","doi-asserted-by":"crossref","first-page":"146445","DOI":"10.1016\/j.brainres.2019.146445","article-title":"Electroencephalography correlates of transcranial direct-current stimulation enhanced surgical skill learning: a replication and extension study","volume":"1725","author":"Ciechanski","year":"2019","journal-title":"Brain Res"},{"key":"2022100812515258100_bjs11601-bib-0020","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/j.wneu.2017.08.123","article-title":"Effects of transcranial direct-current stimulation on neurosurgical skill acquisition: a randomized controlled trial","volume":"108","author":"Ciechanski","year":"2017","journal-title":"World Neurosurg"},{"key":"2022100812515258100_bjs11601-bib-0021","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.neuroimage.2010.11.036","article-title":"TDCS guided using fMRI significantly accelerates learning to identify concealed objects","volume":"59","author":"Clark","year":"2013","journal-title":"Neuroimage"},{"key":"2022100812515258100_bjs11601-bib-0022","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1523\/JNEUROSCI.3687-15.2016","article-title":"Transcranial stimulation of the dorsolateral prefrontal cortex prevents stress-induced working memory deficits","volume":"36","author":"Bogdanov","year":"2016","journal-title":"J Neurosci"},{"first-page":"2008","volume-title":"Working Time Directive 2009: Meeting the Challenge in Surgery","author":"Royal College of Surgeons of England","key":"2022100812515258100_bjs11601-bib-0023"},{"key":"2022100812515258100_bjs11601-bib-0024","doi-asserted-by":"crossref","first-page":"589","DOI":"10.3389\/fnhum.2016.00589","article-title":"The effects of transcranial direct current stimulation (tDCS) on multitasking throughput capacity","volume":"10","author":"Nelson","year":"2016","journal-title":"Front Hum Neurosci"},{"key":"2022100812515258100_bjs11601-bib-0025","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.neuroimage.2012.11.061","article-title":"Enhancing vigilance in operators with prefrontal cortex transcranial direct current stimulation (tDCS)","volume":"85","author":"Nelson","year":"2014","journal-title":"Neuroimage"},{"key":"2022100812515258100_bjs11601-bib-0026","article-title":"Measuring the teamwork performance of operating room teams: a systematic review of assessment tools and their measurement properties","author":"Etherington","year":"2019","journal-title":"J Interprof Care"},{"key":"2022100812515258100_bjs11601-bib-0027","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.amjsurg.2008.03.002","article-title":"Surgical team behaviors and patient outcomes","volume":"197","author":"Mazzocco","year":"2009","journal-title":"Am J Surg"},{"key":"2022100812515258100_bjs11601-bib-0028","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.brs.2016.06.004","article-title":"Safety of transcranial direct current stimulation: evidence based update 2016","volume":"9","author":"Bikson","year":"2016","journal-title":"Brain Stimul"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.11601","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/107\/8\/946\/46379875\/bjs11601.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/107\/8\/946\/46379875\/bjs11601.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T13:24:19Z","timestamp":1665235459000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/107\/8\/946\/6094437"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,26]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,4,26]]},"published-print":{"date-parts":[[2020,6,15]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.11601","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"type":"print","value":"0007-1323"},{"type":"electronic","value":"1365-2168"}],"subject":[],"published-other":{"date-parts":[[2020,7]]},"published":{"date-parts":[[2020,4,26]]}}}