Advertisement

Playing to your skills: a randomised controlled trial evaluating a dedicated video game for minimally invasive surgery

  • Cuan M. Harrington
  • Vishwa Chaitanya
  • Patrick Dicker
  • Oscar Traynor
  • Dara O. Kavanagh
Article

Abstract

Background

Video gaming demands elements of visual attention, hand–eye coordination and depth perception which may be contiguous with laparoscopic skill development. General video gaming has demonstrated altered cortical plasticity and improved baseline/acquisition of minimally invasive skills. The present study aimed to evaluate for skill acquisition associated with a commercially available dedicated laparoscopic video game (Underground) and its unique (laparoscopic-like) controller for the Nintendo®Wii U™ console.

Methods

This single-blinded randomised controlled study was conducted with laparoscopically naive student volunteers of limited (< 3 h/week) video gaming backgrounds. Baseline laparoscopic skills were assessed using four basic tasks on the Virtual Reality (VR) simulator (LAP MentorTM, 3D systems, Colorado, USA). Twenty participants were randomised to two groups; Group A was requested to complete 5 h of video gaming (Underground) per week and Group B to avoid gaming beyond their normal frequency. After 4 weeks participants were reassessed using the same VR tasks. Changes in simulator performances were assessed for each group and for intergroup variances using mixed model regression.

Results

Significant inter- and intragroup performances were present for the video gaming and controls across four basic tasks. The video gaming group demonstrated significant improvements in thirty-one of the metrics examined including dominant (p ≤ 0.004) and non-dominant (p < 0.050) instrument movements, pathlengths (p ≤ 0.040), time taken (p ≤ 0.021) and end score [p ≤ 0.046, (task-dependent)]. The control group demonstrated improvements in fourteen measures. The video gaming group demonstrated significant (p < 0.05) improvements compared to the control in five metrics. Despite encouraged gameplay and the console in participants’ domiciles, voluntary engagement was lower than directed due to factors including: game enjoyment (33.3%), lack of available time (22.2%) and entertainment distractions (11.1%).

Conclusion

Our work revealed significant value in training using a dedicated laparoscopic video game for acquisition of virtual laparoscopic skills. This novel serious game may provide foundations for future surgical developments on game consoles in the home environment.

Keywords

Video gaming Laparoscopy Minimally invasive surgery Technical skills 

Notes

Compliance with ethical standards

Disclosures

Cuan Harrington received a research Grant [Grant Number 1841, 2015] from the Health Service Executive (HSE) Ireland which was non-specific to this study. Vishwa Chaitanya, Patrick Dicker, Dara Kavanagh and Oscar Traynor have no conflicts of interest or financial ties to disclose.

Ethical approval

Ethical approval was granted for this study by the local ethics committee of the Royal College of Surgeons in Ireland (REC1202). All participants gave voluntary and informed consent.

References

  1. 1.
    Boxer P, Groves CL, Docherty M (2015) Video games do indeed influence children and adolescents’ aggression, prosocial behavior, and academic performance: a clearer reading of ferguson (2015). Perspect Psychol Sci 10(5):671–673CrossRefPubMedGoogle Scholar
  2. 2.
    Harrison JO Jr (1964) Computer-aided information systems for gaming. Research Analysis Corporation, McLean, USAGoogle Scholar
  3. 3.
    Bell RH Jr, Biester TW, Tabuenca A, Rhodes RS, Cofer JB, Britt LD, Lewis FR Jr (2009) Operative experience of Residents in US general surgery programs: a gap between expectation and experience. Ann Surg 249(5):719–724CrossRefPubMedGoogle Scholar
  4. 4.
    Harrington CM, Kavanagh DO, Ryan D, Dicker P, Lonergan PE, Traynor O, Tierney S (2017) Objective scoring of an electronic surgical logbook: analysis of impact and observations within a surgical training body. Am J Surg 214(5):962-968CrossRefPubMedGoogle Scholar
  5. 5.
    van Dongen KW, van der Wal WA, Rinkes IH, Schijven MP, Broeders IA (2008) Virtual reality training for endoscopic surgery: voluntary or obligatory? Surg Endosc 22(3):664–667CrossRefPubMedGoogle Scholar
  6. 6.
    Chang L, Petros J, Hess DT, Rotondi C, Babineau TJ (2007) Integrating simulation into a surgical residency program: is voluntary participation effective? Surg Endosc 21(3):418–421CrossRefPubMedGoogle Scholar
  7. 7.
    Lorenz RC, Gleich T, Gallinat J, Kühn S (2015) Video game training and the reward system. Front Hum Neurosci.  https://doi.org/10.3389/fnhum.2015.00040 Google Scholar
  8. 8.
    Green CS, Bavelier D (2012) Learning, attentional control, and action video games. Curr Biol 22(6):197–206CrossRefGoogle Scholar
  9. 9.
    Koepp MJ, Gunn RN, Lawrence AD, Cunningham VJ, Dagher A, Jones T, Brooks DJ, Bench CJ, Grasby PM (1998) Evidence for striatal dopamine release during a video game. Nature 393(6682):266–268CrossRefPubMedGoogle Scholar
  10. 10.
    Kühn S, Romanowski A, Schilling C, Lorenz R, Mörsen C, Seiferth N, Banaschewski T, Barbot A, Barker GJ, Büchel C, Conrod PJ, Dalley JW, Flor H, Garavan H, Ittermann B, Mann K, Martinot JL, Paus T, Rietschel M, Smolka MN, Ströhle A, Walaszek B, Schumann G, Heinz A, Gallinat J (2011) The neural basis of video gaming. Transl Psychiatry 1(11):e53.  https://doi.org/10.1038/tp.2011.53 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Knutson B, Greer SM (2008) Anticipatory affect: neural correlates and consequences for choice. Philos Trans R Soc Lond B Biol Sci 363(1511):3771–3786CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Green CS, Bavelier D (2003) Action video game modifies visual selective attention. Nature 423(6939):534–537CrossRefPubMedGoogle Scholar
  13. 13.
    Granek JA, Gorbet DJ, Sergio LE (2010) Extensive video-game experience alters cortical networks for complex visuomotor transformations. Cortex 46(9):1165–1177CrossRefPubMedGoogle Scholar
  14. 14.
    Schacter DL, Buckner RL (1998) Priming and the Brain. Neuron 20(2):185–195CrossRefPubMedGoogle Scholar
  15. 15.
    Race EA, Shanker S, Wagner AD (2009) Neural priming in human frontal cortex: multiple forms of learning reduce demands on the prefrontal executive system. J Cogn Neurosci 21(9):1766–1781CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Pascual-Leone A, Amedi A, Fregni F, Merabet LB (2005) The plastic human brain cortex. Annu Rev Neurosci 28:377–401CrossRefPubMedGoogle Scholar
  17. 17.
    Cooper SJ (2005) Donald O. Hebb’s synapse and learning rule: a history and commentary. Neurosci Biobehav Rev 28(8):851–874CrossRefPubMedGoogle Scholar
  18. 18.
    Enochsson L, Isaksson B, Tour R, Kjellin A, Hedman L, Wredmark T, Tsai-Fellander L (2004) Visuospatial skills and computer game experience influence the performance of virtual endoscopy. J Gastrointest Surg 8(7):876–882CrossRefPubMedGoogle Scholar
  19. 19.
    Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J (2003) Impact of hand dominance, gender, and experience with computer games on performance in virtual reality laparoscopy. Surg Endosc 17(7):1082–1085CrossRefPubMedGoogle Scholar
  20. 20.
    Rosser JC Jr, Lynch PJ, Cuddihy L, Gentile DA, Klonsky J, Merrell R (2007) The impact of video games on training surgeons in the 21st century. Arch Surg 142(2):181–186CrossRefPubMedGoogle Scholar
  21. 21.
    Stefanidis D, Korndorffer JR Jr, Black FW, Dunne JB, Sierra R, Touchard CL, Rice DA, Markert RJ, Kastl PR, Scott DJ (2006) Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training. Surgery 140(2):252–262CrossRefPubMedGoogle Scholar
  22. 22.
    Shane MD, Pettitt BJ, Morgenthal CB, Smith CD (2008) Should surgical novices trade their retractors for joysticks? Videogame experience decreases the time needed to acquire surgical skills. Surg Endosc 22(5):1294–1297CrossRefPubMedGoogle Scholar
  23. 23.
    Jalink MB, Goris J, Heineman E, Pierie JP, ten Cate Hodemaker HO (2014) Construct and concurrent validity of a Nintendo Wii video game made for training basic laparoscopic skills. Surg Endosc 28(2):537–542CrossRefPubMedGoogle Scholar
  24. 24.
    Jalink MB, Goris J, Heineman E, Pierie JP, Ten Cate Hoedemaker HO (2015) Face validity of a Wii U video game for training basic laparoscopic skills. Am J Surg 209(6):1102–1106CrossRefPubMedGoogle Scholar
  25. 25.
    Jalink MB, Heineman E, Pierie JP, ten Cate Hoedemaker HO (2015) The effect of a preoperative warm-up with a custom-made Nintendo video game on the performance of laparoscopic surgeons. Surg Endosc 29(8):2284–2290CrossRefPubMedGoogle Scholar
  26. 26.
    Houston J, Harris P, McIntire S, Francis D (2002) Revising the competitiveness index using factor analysis. Psychol Rep 90(1):31–34CrossRefPubMedGoogle Scholar
  27. 27.
    McDougall EM, Corica FA, Boker JR, Sala LG, Stoliar G, Borin JF, Chu FT, Clayman RV (2006) Construct validity testing of a laparoscopic surgical simulator. J Am Coll Surg 202(5):779–787CrossRefPubMedGoogle Scholar
  28. 28.
    Harrington CM, Bresler R, Ryan D, Dicker P, Traynor O, Kavanagh DO (2017) The correlation between fundamental characteristics and first-time performance in laparoscopic tasks. Am J Surg.  https://doi.org/10.1016/j.amjsurg.2017.04.015 Google Scholar
  29. 29.
    Giannotti D, Patrizi G, Di Rocco G, Vestri AR, Semproni CP, Fiengo L, Pontone S, Palazzini G, Redler A (2013) Play to become a surgeon: impact of Nintendo Wii training on laparoscopic skills. PLoS ONE.  https://doi.org/10.1371/journal.pone.0057372 Google Scholar
  30. 30.
    Boot WR, Kramer AF, Simons DJ, Fabiani M, Gratton G (2008) The effects of video game playing on attention, memory, and executive control. Acta Psychol 129(3):387–398CrossRefGoogle Scholar
  31. 31.
    Paschold M, Schröder M, Kauff DW, Gorbauch T, Herzer M, Lang H, Kneist W (2011) Virtual reality laparoscopy: which potential trainee starts with a higher proficiency level? Int J CARS 6(5):653–662CrossRefGoogle Scholar
  32. 32.
    Heinrichs WL, Lukoff B, Youngblood P, Dev P, Shavelson R, Hasson HM, Satava RM, McDougall EM, Wetter PA (2007) Criterion-based training with surgical simulators: proficiency of experienced surgeons. JSLS 11(3):273–302PubMedGoogle Scholar
  33. 33.
    Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248(2):166–179CrossRefPubMedGoogle Scholar
  34. 34.
    Ou Y, McGlone ER, Camm CF, Khan OA (2013) Does playing video games improve laparoscopic skills? Int J Surg 11(5):365–369CrossRefPubMedGoogle Scholar
  35. 35.
    Jalink MB, Goris J, Heineman E, Pierie JP, ten Cate Hoedemaker HO (2014) The effects of video games on laparoscopic simulator skills. Am J Surg 208(1):151–156CrossRefPubMedGoogle Scholar
  36. 36.
    Bokhari R, Bollman-McGregor J, Kahoi K, Smith M, Feinstein A, Ferrara J (2010) Design, development, and validation of a take-home simulator for fundamental laparoscopic skills: using Nintendo Wii for surgical training. Am Surg 76(6):583–586PubMedGoogle Scholar
  37. 37.
    Middleton KK, Hamilton T, Tsai PC, Middleton DB, Falcone JL, Hamad G (2013) Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii. Surg Endosc 27(11):4224–4231CrossRefPubMedGoogle Scholar
  38. 38.
    Mentzoni RA, Brunborg GS, Molde H, Myrseth H, Skouverøe KJ, Hetland J, Pallesen S (2011) Problematic video game use: estimated prevalence and associations with mental and physical health. Cyberpsychol Behav Soc Netw 14(10):591–596CrossRefPubMedGoogle Scholar
  39. 39.
    Kononowicz AA, Krawczyk P, Cebula G, Dembkowska M, Drab E, Frączek B, Stachoń AJ, Andres J (2012) Effects of introducing a voluntary virtual patient module to a basic life support with an automated external defibrillator course: a randomised trial. BMC Med Educ 12:41.  https://doi.org/10.1186/1472-6920-12-41 June 18, 2012.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Nicol LG, Walker KG, Cleland J, Partridge R, Moug SJ (2016) Incentivising practice with take-home laparoscopic simulators in two UK Core Surgical Training programmes. BMJ Simul Technol Enhanc Learn 2(4):112–117CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Cuan M. Harrington
    • 1
  • Vishwa Chaitanya
    • 2
  • Patrick Dicker
    • 3
  • Oscar Traynor
    • 1
  • Dara O. Kavanagh
    • 1
  1. 1.Department of Surgical AffairsRoyal College of Surgeons in IrelandDublinIreland
  2. 2.School of MedicineRoyal College of Surgeons in IrelandDublinIreland
  3. 3.Department of Epidemiology and Public Health MedicineRoyal College of Surgeons in IrelandDublinIreland

Personalised recommendations