By Larissa Werneck
For centuries, the idea of enhancing human cognition has captivated scientists and thinkers alike. Early experiments in brain augmentation, such as Roberts Bartholow’s 1874 electrical brain stimulation, laid the foundation for further exploration (Patra et al., 2019). Today, rapid technological advancements and increasing scientific curiosity have led to a surge in neuro-enhancement research (Clark et al., 2014). These innovations are revolutionizing healthcare, particularly in surgery, where they are used therapeutically (Giordano, 2012) and to enhance surgical performance (Patel et al., 2020). As research in this area expands, neuro-enhancement technologies hold the potential to revolutionize surgical practice, pushing the limits of precision, stamina, and ethics. How will this rapidly evolving field reshape the future of surgery?
Neuro-enhancement technologies are various tools aimed at optimizing cognitive and neurological functions, either by enhancing existing abilities or compensating for deficits (Giordano, 2012). Examples of these technologies include brain-computer interfaces (BCIs), neurofeedback devices, and neuroprosthetics (Brenninkmeijer et al., 2017). Deep brain stimulation (DBS), for instance, targets specific brain regions to alleviate symptoms of conditions like Parkinson’s tremors (Sironi, 2011).
While initially developed for therapeutic use, these technologies are increasingly being applied in high-performance fields like surgery, where cognitive enhancement can be critical. Neurofeedback, a biofeedback technique that trains individuals to voluntarily regulate brain activity (Weiskopf et al., 2004b), has been investigated as a potential tool in reducing surgical burnout. In one study involving fifteen surgical residents, cognitive workload was measured using electroencephalography (EEG) and neurofeedback intervention was found to significantly improve cognitive workload (Kratzke et al., 2021). EEG patterns shifted from those indicative of post-traumatic stress disorder to a more efficient neural network (Kratzke et al., 2021). Similarly, transcranial direct-current stimulation (tDCS), a non-invasive technique that uses electrodes to modulate cortical activity, has been associated with enhanced attention and surgical skills, such as laparoscopic surgical skills (Ciechanski et al., 2018, Ciechanski et al., 2019).
The future of neuro-enhancement technology in surgery is rapidly advancing as companies like Elon Musk’s Neuralink push the boundaries of brain-machine interfaces (Musk and Neuralink, 2019). Recent breakthroughs, such as noninvasive brain-computer interfaces controlling robotic devices (Durham, 2019), hint at a future where surgeons could operate using only their thoughts. Augmented reality (AR), already making strides in the operating room, allows surgeons to visualize complex anatomical structures and plan procedures with great precision (Connolly, 2024). The potential for integrating AR with neurofeedback systems could enhance decision-making and situational awareness, propelling surgical performance to new heights.
However, despite these exciting advancements, ethical challenges must be addressed. Autonomy and equity are key concerns, as widespread adoption of neurotechnologies may pressure surgeons to incorporate them, potentially undermining their autonomy (Patel et al., 2020). The rising demand for advanced neurotechnology could also exacerbate socioeconomic disparities, as access to these tools may become limited to those who can afford them, thereby widening the gap in healthcare equality (Jangwan et al., 2022). Balancing the benefits of neuro-enhancement with ethical considerations will be crucial as the field advances.
Ultimately, neuro-enhancement technologies could profoundly impact the future of surgery, offering improvements in precision and cognitive endurance. However, addressing the ethical implications of their use, such as accessibility and autonomy, will be as important as the technological advancements themselves. The future of surgery may well depend on the synergy between human skill and neuro-enhancement technology, but careful thought will be required to navigate this evolving landscape.
Larissa Werneck is a third-year medical student at the University of Incarnate Word School of Osteopathic Medicine (UIWSOM) in San Antonio, TX. She earned a Bachelor of Arts in Neuroscience from Boston University (BU) and went on to complete a Master of Science in Biomedical Sciences, along with a Certificate in Genomics and Predictive Health, from Florida Atlantic University (FAU). Outside of medical school, Larissa enjoys fostering dogs from local rescues, gardening, and cooking!