title: Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii.
abstract: BACKGROUND
  Video games have been shown to improve eye-hand coordination, spatial visualization, manual dexterity, and rapid mental processing, which are important in the acquisition of laparoscopic skills. This study investigated the relationship between playing Nintendo(®) Wii™ and virtual reality (VR) laparoscopic surgery simulator performance. We hypothesized that playing the Wii would improve surgical skills performance on a VR laparoscopic simulator and hoped to elucidate which tasks, in particular, would be most beneficial for nondominant hand training.
  
  
  METHODS
  This was a single-blinded, randomized, prospective study conducted with 23 student volunteers. VR laparoscopic skills were assessed at baseline on a Simbionix LapMentor™ Surgical Simulator (Simbionix Ltd., Israel) and after the gaming period of 2 weeks. Simulator performance metrics were compared between groups using nonparametric statistics and an alpha of 0.05.
  
  
  RESULTS
  Compared with the control group, the Wii-playing group demonstrated greater improvement of six measures, including accuracy on the eye-hand coordination task (p = 0.04), faster completion time (p = 0.04), decreased number of left-handed movements (p = 0.03), decreased left handed total path length (p = 0.03), decreased total number of grasping attempts (p = 0.04), and improved left-handed economy of movement (p = 0.05) for the bimanual clipping and grasping task. When comparing the number of measures improved upon by the Wii-playing group and the control group for all three tasks, the Wii-playing group consistently outperformed the control group in 18 measures compared with the control group's improvement in 6.
  
  
  CONCLUSIONS
  This study further characterizes the association between video game playing and surgical performance. Improvements following the intervention were made in the most basic of surgical skills, most notably with the nondominant hand, suggesting that short-term playing of the Wii could improve bimanual dexterity and expedite the acquisition of basic surgical skills.
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, 3945 Forbes Avenue, Suite 325, Pittsburgh, PA, 15213, USA, midddletonkk@upmc.edu.
authors.forename: Kellie K
authors.initials: KK
authors.lastname: Middleton
authors.forename: Travis
authors.initials: T
authors.lastname: Hamilton
authors.forename: Pei-Chien
authors.initials: PC
authors.lastname: Tsai
authors.forename: Dana B
authors.initials: DB
authors.lastname: Middleton
authors.forename: John L
authors.initials: JL
authors.lastname: Falcone
authors.forename: Giselle
authors.initials: G
authors.lastname: Hamad
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D056228:Feedback, Sensory / Q000502:physiology; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D018910:Video Games; D055815:Young Adult