Validation of a video game made for training laparoscopic skills

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, a 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 minute 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 preoperative warm-up in an experimental setting.