The Effect of Video Game “Warm-up” on Performance of Laparoscopic Surgery Tasks

Rosser, James C.; Gentile, Douglas A.; Hanigan, Kevin; Danner, Omar K.

doi:10.4293/108680812x13291597715664

Cited by 44 publications

(44 citation statements)

References 25 publications

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“…To a lesser degree, higher PGY level was associated with better virtual procedure scores and shorter procedure time. Finally, although previous research has correlated video game exposure with laparoscopic surgical skill [25], this trend was not observed in our data. Increased gaming experience in the nonexperts was not enough to accommodate for limited arthroscopic exposure.…”

Section: Discussioncontrasting

confidence: 96%

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Chang

Banaszek

Gambrel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Work-hour restrictions and fatigue management strategies in surgical training programs continue to evolve in an effort to improve the learning environment and promote safer patient care. In response, training programs must reevaluate how various teaching modalities such as simulation can augment the development of surgical competence in trainees. For surgical simulators to be most useful, it is important to determine whether surgical proficiency can be reliably differentiated using them. To our knowledge, performance on both virtual and benchtop arthroscopy simulators has not been concurrently assessed in the same subjects. Questions/purposes (1) Do global rating scales and procedure time differentiate arthroscopic expertise in virtual and benchtop knee models? (2) Can commercially available built-in motion analysis metrics differentiate arthroscopic expertise? (3) How well are performance measures on virtual and benchtop simulators correlated? (4) Are these metrics sensitive enough to differentiate by year of training? Methods A cross-sectional study of 19 subjects (four medical students, 12 residents, and three staff) were recruited and divided into 11 novice arthroscopists (student to Postgraduate Year [PGY] 3) and eight proficient arthroscopists (PGY 4 to staff) who completed a diagnostic arthroscopy and loose-body retrieval in both virtual and benchtop knee models. Global rating scales (GRS), procedure times, and motion analysis metrics were used to evaluate performance. CI, seconds, p = 0.002). The built-in motion analysis metrics also distinguished novices from proficient arthroscopists using the self-generated virtual loose body retrieval task scores (4 ± 1 [95% CI, 3-5] versus 6 ± 1 [95% CI, 5-7], p = 0.001). GRS scores between virtual and benchtop models were very strongly correlated (q = 0.93, p \ 0.001). There was strong correlation between year of training and virtual GRS (q = 0.8, p \ 0.001) and benchtop GRS (q = 0.87, p \ 0.001) scores. Conclusions To our knowledge, this is the first study to evaluate performance on both virtual and benchtop knee simulators. We have shown that subjective GRS scores and objective motion analysis metrics and procedure time are valid measures to distinguish arthroscopic skill on both virtual and benchtop modalities. Performance on both modalities is well correlated. We believe that training on artificial models allows acquisition of skills in a safe environment. Future work should compare different modalities in the efficiency of skill acquisition, retention, and transferability to the operating room.123 Clin Orthop Relat Res (2016) 474:956-964 DOI 10.1007/s11999-015-4510-8 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® GRS scales. The proficient subjects completed nearly all tasks faster

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Section: Discussioncontrasting

confidence: 96%

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Chang

Banaszek

Gambrel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…With modern generations of orthopedic trainees being exposed to virtual reality worlds and video-gaming, we recently demonstrated that there was no correlation between video-gaming experience and gaining of competency on a VR DHS simulator (Khatri et al 2014), which is contrary to the current literature on general surgical simulators (Rosenberg et al 2005, Rosser et al 2007, Badurdeen et al 2010, Rosser et al 2012, Giannotti et al 2013). …”

Section: Discussionmentioning

confidence: 57%

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

et al. 2015

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Background and purpose — Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics.Patients and methods — 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05.Results — The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training.Interpretation — We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.

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“…A further four studies were case studies, two compared a technical skills practice to no practice [30,31] and two [32,33] did not contain a control group. One RCT [34] examined the effect of mental practice prior to an operation on subsequent laparoscopic performance.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five of the included studies [24,25,27,31,33] reported `pureÕ performance timedefined as the time taken to perform an assessed task. Those articles that reported duration as part of a global rating scale were not included as such studies have been discussed above.…”

Section: Studies Reporting Performance Timementioning

confidence: 99%

“…In three studies [26,31,32] a time-based score was reported, either in combination with errors made (resulting in a time penalty) or as the number of occasions a task was performed within a set time. The authors in one case study [32] found that preoperative simulation increases the number of times a laparoscopic task can be performed within a set time period.…”

Section: Studies Reporting Time-based Scorementioning

confidence: 99%

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A systematic examination of preoperative surgery warm-up routines

et al. 2016

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Background: Recent evidence indicates that a preoperative warm-up is a potentially useful tool in facilitating performance. But what factors drive such improvements and how should a warm-up be implemented? Methods:In order to address these issues, we adopted a two-pronged approach: (i) we conducted a systematic review of the literature to identify existing studies utilizing preoperative simulation techniques; (ii) we performed task analysis to identify the constituent parts of effective warm-ups. We identified five randomised control trials, four randomised crossover trials and four case series. The majority of these studies reviewed surgical performance following preoperative simulation relative to performance without simulation.Results: Four studies reported outcome measures in real patients and the remainder reported simulated outcome measures. All but one of the studies found that preoperative simulation improves operative outcomes-but this improvement was not found across all measured parameters. Whilst the reviewed studies had a number of methodological issues, the global data indicate that preoperative simulation has substantial potential to improve surgical performance. Analysis of the task characteristics of successful interventions indicated that the majority of these studies employed warm-ups that focused on the visual motor elements of surgery. However, there was no theoretical or empirical basis to inform the design of the intervention in any of these studies. Conclusions:There is an urgent need for a more rigorous approach to the development of Ôwarm-upÕ routines if the potential value of preoperative simulation is to be understood and realised. We propose that such interventions need to be grounded in theory and empirical evidence on human motor performance.

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The Effect of Video Game “Warm-up” on Performance of Laparoscopic Surgery Tasks

Abstract: This study suggests that those who “warm-up” with select video games may have improved laparoscopic clinical task performance compared to those not engaged in “warm-up.”

Cited by 44 publications

References 25 publications

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

A systematic examination of preoperative surgery warm-up routines

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