1. Comparing Video Games and Laparoscopic Simulators in the Development of Laparoscopic Skills in Surgical Residents Barbara J. Adams MD, Franklin Margaron MD, Brian J. Kaplan MD Department of Surgery, Virginia Commonwealth University

2. No disclosures Disclosures

3. Laparoscopic Surgery Requires Specialized Training Laparoscopic surgery is an essential part of training and practice Laparoscopic procedures present unique set of challenges –Decreased tactile feedback –Fulcrum effect –Impaired depth perception –3D actions while looking at 2D screens

4. Laparoscopic Simulators –Virtual Reality –Box Trainers SAGES developed Fundamentals of Laparoscopic Surgery (FLS) –Cognitive –Physical Model Advent of Simulation Trainers

5. Cost Accessibility Maintenance Conflicts with duty hours Portability Obstacles to Simulators

6. Video game industry sales >$18 billion Games offer photorealistic simulations, demanding same visual-motor dexterity sought in surgical residents Playing video games as a child garners skills –Faster reaction times –Improved hand-eye coordination –Improved neuropsychological tests –Better spatial visualization –Increased mental rotation Griffith, J.L., et al., Differences in eye-hand motor coordination of video-game users and non-users. Percept Mot Skills, 1983. 57(1): p. 155-8. Video Games as Teachers

7. Many types of consoles available –Traditional controller platforms –Newer motion sensing technology –Handheld video games Handheld games have advantages –Cheaper –Portable

8. How do video games compare to traditional laparoscopic simulators? Do handheld game systems confer the same skills as full consoles? Hypothesis

9. IRB approved prospective controlled study 31 general surgery residents Initial Survey on experience –Laparoscopic surgery –Laparoscopic trainers –Video game systems Initial timed test on box trainer –FLS peg transfer Methods: The Participants

10. Random assignment to 1 of 3 groups –Box Trainer –XBOX 360® –Nintendo DS® Each gaming system used the game Call of Duty 4: Modern Warfare ® –First person shooter –Rapid, precise targeting –Complex motor coordination Residents given 6 weeks to “train” Retested on box trainer peg transfer at conclusion Methods: The Training

12. Resident Demographics Among the 3 Groups

13. Residents assigned to XBOX 360® spent more time on their trainer, average 5.7 hours Nintendo DS® residents spent an average 2.9 hours Traditional box trainer residents spent an average 1.8 hours XBOX 360 ® enabled residents to enjoy cooperative play –Relationship building Residents assigned to video games showed more compliance

14. Video game trained residents improved more than Box Trainer p=0.052

15. Box Trainer Times Based on Gaming and Laparoscopic Experience p<0.05

16. Laparoscopic surgery requires unique skills Training is much more difficult with new work restrictions Virtual simulators are expensive and may elicit less interest Video games are popular, realistic and cheap compared with simulators Surgeons who were raised playing video games have faster reaction times, dexterity and mental rotation ability Summary

17. Residents assigned to XBOX 360® console improved the most and had highest compliance Residents with laparoscopic or gaming experience performed the best initially Residents without any previous experience improved the most As video games become increasingly involved in our daily lives, medicine should also embrace this technology for training Summary

18. Small sample size One component FLS Reliable reporting by residents Loyalty to study arm Accessibility of games over simulator Limitations