title: Impact of perceptual ability and mental imagery training on simulated laparoscopic knot-tying in surgical novices using a Nissen fundoplication model.
abstract: BACKGROUND
  Performing minimally invasive surgery requires training and visual-spatial intelligence. The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices.
  
  
  METHODS
  A total of 40 medical students randomly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator (SimSurgery®, Oslo, Norway). The variables time and tip trajectory (total path length of the instrument tip trajectory) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model. The experimental group completed additional mental practice during the interval between the two training sessions. All performed a cube subtest of a standard intelligence test (I-S-T 2000 R) to evaluate visual-spatial ability.
  
  
  RESULTS
  All participants achieved an improvement in time (t = 9.861; p < 0.001) and tip trajectory (t = 6.833; p < 0.001) in the second training session. High scores on the visual-spatial test correlated with a faster performance (r = -0.557; p < 0.001) and more precise movements (r = -0.377; p = 0.016). Comparison of the two groups did not show any statistical significant differences in the parameters time and tip trajectory.
  
  
  CONCLUSIONS
  Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices. Additional mental practice did not improve the overall knot-tying performance. Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks.
authors: Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany.
authors: F
authors: F
authors: Jungmann
authors: I
authors: I
authors: Gockel
authors: H
authors: H
authors: Hecht
authors: K
authors: K
authors: Kuhr
authors: J
authors: J
authors: Räsänen
authors: E
authors: E
authors: Sihvo
authors: H
authors: H
authors: Lang
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D018662:Fundoplication / Q000379:methods; D005858:Germany; D006801:Humans; D007092:Imagination; D007361:Intelligence Tests; D010535:Laparoscopy / Q000193:education*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D017145:Models, Educational; D013028:Space Perception; D013536:Suture Techniques / Q000193:education*; D013647:Task Performance and Analysis; D013997:Time Factors; D014796:Visual Perception