title: Comparing video games and laparoscopic simulators in the development of laparoscopic skills in surgical residents.
abstract: BACKGROUND
  The video game industry has become increasingly popular over recent years, offering photorealistic simulations of various scenarios while requiring motor, visual, and cognitive coordination. Video game players outperform nonplayers on different visual tasks and are faster and more accurate on laparoscopic simulators. The same qualities found in video game players are highly desired in surgeons. Our investigation aims to evaluate the effect of video game play on the development of fine motor and visual skills. Specifically, we plan to examine if handheld video devices offer the same improvement in laparoscopic skill as traditional simulators, with less cost and more accessibility.
  
  
  METHODS
  We performed an Institutional Review Board-approved study, including categorical surgical residents and preliminary interns at our institution. The residents were randomly assigned to 1 of 3 study arms, including a traditional laparoscopic simulator, XBOX 360 gaming console, or Nintendo DS handheld gaming system. After an introduction survey and baseline timed test using a laparoscopic surgery box trainer, residents were given 6 weeks to practice on their respective consoles. At the conclusion of the study, the residents were tested again on the simulator and completed a final survey.
  
  
  RESULTS
  A total of 31 residents were included in the study, representing equal distribution of each class level. The XBOX 360 group spent more time on their console weekly (6 hours per week) compared with the simulator (2 hours per week), and Nintendo groups (3 hours per week). There was a significant difference in the improvement of the tested time among the 3 groups, with the XBOX 360 group showing the greatest improvement (p = 0.052). The residents in the laparoscopic simulator arm (n = 11) improved 4.6 seconds, the XBOX group (n = 10) improved 17.7 seconds, and the Nintendo DS group (n = 10) improved 11.8 seconds. Residents who played more than 10 hours of video games weekly had the fastest times on the simulator both before and after testing (p = 0.05). Most residents stated that playing the video games helped to ease stress over the 6 weeks and cooperative play promoted better relationships among colleagues.
  
  
  CONCLUSIONS
  Studies have shown that residents who engage in video games have better visual, spatial, and motor coordination. We showed that over 6 weeks, residents who played video games improved in their laparoscopic skills more than those who practiced on laparoscopic simulators. The accessibility of gaming systems is 1 of the most essential factors making these tools a good resource for residents. Handheld games are especially easy to use and offer a readily available means to improve visuospatial and motor abilities.
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, VA 23223, USA. badams2@mcvh-vcu.edu
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Adams
authors.forename: Franklin
authors.initials: F
authors.lastname: Margaron
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010535:Laparoscopy / Q000193:education*; D008297:Male; D011446:Prospective Studies; D018910:Video Games