title: The effect of a preoperative warm-up with a custom-made Nintendo video game on the performance of laparoscopic surgeons.
abstract: BACKGROUND
  It has previously been shown that short, pre-operative practice with a simulator, box trainer, or certain video games can temporarily improve one's basic laparoscopic skills; the so-called warm-up effect. In this experiment, we tested the hypothesis that Underground video game made for training basic laparoscopic skills, can also be used for a pre-operative warm-up.
  
  
  METHODS
  29 laparoscopic experts were randomized into two different groups, which were tested on two different days. Group 1 (n = 16) did a laparoscopic skill baseline measurement using the FLS peg transfer test and the Top Gun cobra rope drill on day 1, and did the same tests on day 2 after a 15 min session with the Underground game. Group 2 (n = 13) did the same, but started with the video game, followed by baseline measurement on day 2. This way, each participant served as its own control. Video recordings of both tasks were later analyzed by two blinded reviewers.
  
  
  RESULTS
  On day 1, group 2 was 14.33 % (P = 0.037) faster in completing the peg transfer test. A trend toward better cobra rope scores is also seen. When comparing the average improvement between both days, group 1--which used the game as a warm-up on day 2--showed a 19.61 % improvement in cobra rope score, compared to a 0.77 % score decrease in group 2 (P = 0.002).
  
  
  CONCLUSIONS
  This study shows that the Underground video game can be used as a pre-operative warm-up in an experimental setting.
authors.affiliation: Department of Surgery, University Medical Center Groningen, University of Groningen, Internal postal code FC33, room N2.11/ING 27, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands, maartenjalink@hotmail.com.
authors.forename: M B
authors.initials: MB
authors.lastname: Jalink
authors.forename: E
authors.initials: E
authors.lastname: Heineman
authors.forename: J P E N
authors.initials: JP
authors.lastname: Pierie
authors.forename: H O
authors.initials: HO
authors.lastname: ten Cate Hoedemaker
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D057234:Preoperative Period; D011897:Random Allocation; D066231:Surgeons; D018910:Video Games