Video Games Hone Laparoscopic Surgery Skills

NEW YORK, Feb. 19 -- Video game skills may give younger surgeons a leg up on more experienced practitioners for laparoscopic procedures, according to a small study.

Surgeons who played video games at least three hours a week in their past were 27% faster, with 37% fewer errors, in simulations of laparoscopic surgery than nonplayers, reported James C. Rosser Jr., M.D., of Beth Israel Medical Center here, and colleagues in the February issue of the journal Archives of Surgery.

Among the 33 residents and attending physicians in Dr. Rosser's Top Gun Laparoscopic Skills and Suturing training program, those who currently played video games committed 32% fewer errors and were 24% faster than nonplayers.

In a regression analysis, past and current video gaming were the most important factors in laparoscopic simulation performance, even more so than traditional factors, such as years of training and number of laparoscopic cases.

"It is likely that video game skills are a better predictor of demonstrated laparoscopic skills and suturing than years of experience with laparoscopy because many laparoscopic procedures do not require the advanced skill sets as measured in the course," they said.

While the researchers acknowledged indiscriminant video game playing is not a panacea, they suggested that the visuospatial and other skills acquired through video games may help physicians through the "learning curve" for laparoscopic procedures and thus improve patient safety.

The idea is a seductive one, said Myriam J. Curet, M.D., of Stanford University Medical Center, in an invited critique published alongside the study.

"Now kids and guilty parents do not have to argue about the electronic babysitter -- this is an investment in the children's future!" wrote Dr. Curet, tongue in cheek.

However, she cautioned that the study was small and not designed to demonstrate a benefit for patients in mortality or safety and that higher scores on the laparoscopic simulation do not indicate competency.

"Although it seems intuitive that video game skills can translate to improved laparoscopic skills," she added, "further studies are needed before we include video game play as an adjunct for skill training in laparoscopic surgery or before we relax our concerns about video game playing among children."

The study was spurred by anecdotal observations of young surgeons, the researchers said.

It included a group of 12 attending physicians with an average 12.9 years of surgical experience (mean 239 laparoscopic cases performed) and 21 residents with an average 3.1 years of experience (mean 46 laparoscopic cases performed).

The 1.5-day long course started with questionnaires then moved to preparatory laparoscopic drills. Afterward, they practiced interrupted suturing on porcine intestine.

The drills included the Cobra Rope Drill in which the participants unwound and passed a string using two standardized laparoscopic graspers, the Terrible Triangle Drill in which they lifted and moved triangular objects using an instrument with their nondominant hand, and the Cup Drop Drill in which they moved beans into a cup with a 1-cm opening using a laparoscopic grasper with their nondominant hand.

The researcher also took participants in groups of three for 25-minute sessions playing "over-the-counter" video games emphasizing skills similar to those used in laparoscopic surgery and suturing.

The researchers found the 27% of surgeons who reported more than three hours per week playing video games in the past had 42% better overall scores in the program than the 42% who reported never playing video games (P<0.01). The results were:

• Never players took longer to complete the drills (5224 seconds) than surgeons who reported having played 0 to 3 h/wk (27% of the cohort, 4135 seconds) or those who spent more than three hours per week at it, 3,802 seconds, (P=0.03 versus never players).
• Never players also made more errors in the drills (314 errors) than surgeons who played 0 to three hours per week (257 errors) or those who played more than 3 h/wk (197 errors, P=0.03 versus never players).
• Those who ever reported playing video games in the past scored 33% better overall than never players (P=0.005).

The 36% who reported that they still played video games had scores 26% better overall in the program than those who did not currently play video games (P=0.005). They also made 32% fewer errors (P=0.04) and were 24% faster (P=0.04).

Those who scored in the top tertile when playing video games in the program made 47% fewer errors, were 39% faster, and scored 41% better overall than those in the lowest tertile (P=0.001 for all).

Demonstrated skill while playing video games appeared to be the biggest factor in predicting overall scores (P=0.001) followed by amount of past experience with video games (P=0.03). However, the number of years of training, number of laparoscopic surgeries performed, and gender were not good predictors, Dr. Rosser and colleagues said.

They concluded that medicine may be able to tap into video games for training and getting surgeons familiar with a graphic interface similar to the way the Army uses violent video games to train its special operations forces.

"Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery," they wrote. "Video games may be a practical teaching tool to help train surgeons."

However, Dr. Curet said the lesson to be learned from the study is much narrower.

"Perhaps those surgeons with a demonstrated skill in video gaming or with significant past playing could use video games to help learn laparoscopic skills," she wrote, "while those surgeons with little to no skill in video gaming should use other learning modalities to become competent laparoscopic surgeons."