title: Validation of the mobile serious game application Touch Surgery™ for cognitive training and assessment of laparoscopic cholecystectomy.
abstract: Touch Surgery™(TS) is a serious gaming application for cognitive task simulation and rehearsal of key steps in surgical procedures. The aim was to establish face, content, and construct validity of TS for laparoscopic cholecystectomy (LC). Furthermore, learning curves with TS and a virtual reality (VR) trainer were compared in a randomized trial.
  
  
  
  The performance of medical students and general surgeons was compared for all three modules of LC in TS to establish construct validity. Questionnaires assessed face and content validity. For analysis of learning curves, students were randomized to train on VR or TS first, and then switched to the other training modality. Performance data were recorded.
  
  
  
  54 Surgeons and 51 medical students completed the validation study. Surgeons outperformed students with TS: patient preparation (students = 45.0 ± 19.1%; surgeons = 57.3 ± 15.2%; p < 0.001), access and laparoscopy (students = 70.2 ± 10.9%; surgeons = 75.9 ± 9.7%; p = 0.008) and LC (students = 69.8 ± 12.4%; surgeons = 77.7 ± 9.6%; p < 0.001). Both groups agreed that TS was a highly useful and realistic application. 46 students were randomized for learning curve analysis. It took them 2-4 attempts to reach a 100% score with TS. Training with TS first did not improve students' performance on the VR trainer; however, students who trained with VR first scored significantly higher in module 3 of TS.
  
  
  
  TS is an accepted serious gaming application for learning cognitive aspects of LC with established construct, face, and content validity. There appeared to be a synergy between TS and the VR trainer. Therefore, the two training modalities should accompany one another in a multimodal training approach to laparoscopy.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Karl-Friedrich
authors.initials: KF
authors.lastname: Kowalewski
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Hendrie
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Mona W
authors.initials: MW
authors.lastname: Schmidt
authors.affiliation: Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Proctor
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Sai
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Carly R
authors.initials: CR
authors.lastname: Garrow
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Hannes G
authors.initials: HG
authors.lastname: Kenngott
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. felix.nickel@med.uni-heidelberg.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Nickel
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence / Q000706:statistics & numerical data; D003071:Cognition / Q000502:physiology; D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D063731:Mobile Applications / Q000706:statistics & numerical data*; D010865:Pilot Projects; D015203:Reproducibility of Results; D013337:Students, Medical / Q000706:statistics & numerical data; D066231:Surgeons / Q000193:education*; D011795:Surveys and Questionnaires; D018910:Video Games; D000076142:Virtual Reality
keywords: Cholecystectomy; Education; Laparoscopy; Minimally invasive surgery; Touch Surgery