1. Minimal Invasive Surgery
Murielle Brohez, MD

2. Digital Century

3. Video Games: an Advantage for Young MIS Surgeons

4. Positive Effects from Previous Studies
Early Studies evaluated psychomotor skills Video gamers showed:
superior eye-hand coordination
faster reaction times
superior spatial visualization skills
increased capacity for visual attention and spatial distribution
Griffith, Voloschin, Gibb, Bailey; Perceptual and Motor Skills,19832.
Yuji H; Perceptual and Motor Skills,
Dorval, Pepin; Perceptual and Motor

5. The Impact of Video Games on Training SURGEONS in the 21st Century Rosser Jr, MD; et al.
Arch Surg. 2007;142(2):
Video games are extensively integrated into popular culture
Anecdotal observations of young surgeons suggest that video game play contributes to performance excellence in laparoscopic surgery
Hypothesis  There is a potential link between video game play and laparoscopic surgical skill and suturing

6. Design  Cross-sectional analysis of the performance of surgical residents and attending physicians participating in the Rosser Top Gun Laparoscopic Skills and Suturing Program (Top Gun)
Participants  Thirty-three residents and attending physicians participating in Top Gun from May 10 to August 24, 2002.

7. Main Outcome Measures  The primary outcome measures were compared between participants' laparoscopic skills and suturing capability, video game scores, and video game experience.
Results 
Video Game players 33% better (P<.005)
More than 3 h/wk >42 % better (P<.01)
Current video game players 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005)

8. Conclusions
Video game skill correlates with laparoscopic surgical skills
Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery
Video games may be a practical teaching tool to help train surgeons

9. Benefits of Laparoscopy
Benefits of laparoscopy are mostly derived postoperatively
 pain
attenuated stress response
earlier return to ambulation after lap procedures   postoperative complications + quicker return to full activity

10. Historical Background
Heinz Kalk, a german gastroenterologist
Up to 1970 – Jurgen Nord, USF
1987 – Phillipe Mouret, Lyons France
technique first limited to dx of intraperitoneal TB + disseminated cancer
extent of operation limited by need for surgeon to view abd through eyepiece

11. Hernia
More than 600,000 hernias are repaired annually in the United States

14. Hernia Surgery - History
Edwin Smith Papyrus

15. Medieval Times

16. Beuk repair

17. Techniques of Traditional Open Repair
-Lucas-Championnière Bassini Lotheissen McVay Shouldice Lichtenstein 1987

18. Laparoscopic Repair
? Less pain
? Can it be done

19. Anterior Abdominal Wall

20. Totally Extra Peritoneal

21. TEP anatomy

22. Mesh layout

23. Body Contour

24. TEP Video

25. TEP Indications: Recurrent Bilateral Active lifestyle
Contraindications:
Strangulated
Hypotensive/sepsis

26. TEP post-op SDS Minimal narcotic intake Return to work 3-5 days
Return to golf / running 3-5 days
Return to full activity within days

27. MIS at SOMC Hernias Appendectomy Cholecysctetomy Colectomy
Anti-reflux Surgery – Nissen Fudoplication
Diagnostic Laparoscopy
Lysis of Adhesions
Biopsies

28. Thank You