New study shows electric nudge can aid surgical robot operators

This research from Johns Hopkins University offers the first insight into how stimulating a specific brain area, the cerebellum, could assist healthcare professionals in transitioning skills from virtual reality training to actual surgical environments. This transition is crucial in a field increasingly dependent on digital simulation training, explained Jeremy D. Brown, the author of the study and a roboticist at Johns Hopkins University.

Brown, who is the John C. Malone Associate Professor of Mechanical Engineering, remarked: "Training in virtual reality differs from real-life training, and previous research indicates the difficulty in transferring skills from a simulated to a real environment. Our study suggests that people can transfer skills from virtual reality to the real world much more effectively when they receive this stimulation."

The study, published in December 2023 in Nature Scientific Reports, outlines the experiment, which had participants use the da Vinci Research Kit, an open-source research robot, to navigate a surgical needle through three small holes, first in a virtual simulation and then in a real-life scenario. These exercises simulated movements needed for surgical procedures on abdominal organs, the researchers noted.

Participants were subjected to a subtle flow of electricity through scalp electrodes, targeting the cerebellum. Half of the group received a constant flow of electricity throughout the test, while the other half only received a brief stimulation at the start and no further stimulation during the remainder of the tests. Those who received continuous electric currents demonstrated a significant improvement in dexterity, despite having no prior training in surgery or robotics.

"The group without stimulation found it more challenging to apply the skills they learned in virtual reality to the actual robot, especially for complex movements involving swift actions," stated Guido Caccianiga, a former Johns Hopkins roboticist and current researcher at the Max Planck Institute for Intelligent Systems, who designed and led the experiments. "Those who received brain stimulation performed better in these tasks."

This potential breakthrough for not only learning, but improved operation of those using this type of robotics comes at a time of great interest in the healthcare robotics industry; in the last eight years, the surgical robotics industry quadrupled to more than $3 billion and is positioned to continue to balloon throughout the next decade. Equally, other breakthroughs in the industry, like the researchers at the Swiss Federal Institute of Technology Lausanne having developed a robotic system that allows surgeons to operate with four arms – two controlled by hands and two by feet - has been successful in enabling surgeons to perform intricate tasks usually requiring multiple people.

Non-invasive brain stimulation can externally influence specific brain parts and has been shown to aid motor learning in rehabilitation therapy. This research extends its application to training surgeons in acquiring skills needed in real-life situations, said Co-author Gabriela Cantarero, formerly an assistant professor of physical medicine and rehabilitation at Johns Hopkins.

Cantarero expressed excitement over the study's ability to impact behaviour, noting the precision in quantifying participants' movements, deviations, and errors. Robotic surgery systems enhance clinicians' capabilities, aiding in minimising hand tremors and executing delicate tasks with improved precision.

This brain stimulation research not only influences future surgeons' skill development but also holds promise for skill acquisition in other sectors reliant on virtual reality training, especially robotics. The study suggests that such stimulation could facilitate general skill learning, even outside virtual reality contexts.

"Imagine if brain stimulation could help you learn new skills in half the time," said Caccianiga. "This would significantly reduce training costs, allowing faster training of more surgeons or engineers who will frequently engage with these technologies in the future."