Are Video Game Players Better at Laparoscopic Surgical Tasks?

7/30/2019 Are Video Game Players Better at Laparoscopic Surgical Tasks?

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Are Video Game PlayersAre Video Game Players

Better at LaparoscopicBetter at Laparoscopic

Surgical Tasks?Surgical Tasks?

James C. Rosser Jr. MD1, Paul J. Lynch MD1,2

Laury A. Haskamp BS3, Asaf Yalif MD1, DouglasA. Gentile PhD4,5, Liza Giammaria MD, MPH1

1. Beth Israel Medical Center, 2. NYU Medical Center, 3. Albert Einstein College of Medicine, 4. Iowa State

University, 5. National Institute on Media and the Family


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StatisticsStatistics

z Video game salesin the US

approached $10billion and $20billion worldwide

in 20021

1. Howard, USA TODAY, 12/23/2002


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StatisticsStatistics

z 94% of adolescents

play video games foran average of 9 hoursper week (13 hours

for boys)1

z Average age of a

video gamer is now29 years old2

1. Gentile DA, Lynch PJ, Linder JR, Walsh DA;Journal of Adolescence, 2003

2. Interactive Digital Software Association; URL www.idsa.com


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Negative EffectsNegative Effectsof Video Games from Previous Studiesof Video Games from Previous Studies

Video gaming has been correlated with:

z Decreased Academic Performance1

z Decreased Prosocial Behavior2

z Aggressive Thoughts, Feelings, Behavior2

1. Gentile DA, Lynch PJ, Linder JR, Walsh DA;Journal of Adolescence, 2004

2. Gentile DA, Anderson;Media Violence and Children, 2003


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Negative EffectsNegative Effectsof Video Games from Previous Studiesof Video Games from Previous Studies

Video gaming has been correlated with:

z Smoking1

z Obesity2

z Physiological Arousal (SBP, DBP, HR, Epi,

NE, Testosterone)3,4

1. Kasper et. Al., 1999

2. Subrahmanyam K, et. Al.; Future child, 20003. Lynch, PJ; Psychosomatic Medicine, 1994

4. Lynch, PJ; Psychosomatic Medicine, 1998


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Factors influencing the longFactors influencing the long--

term effects of video gamesterm effects of video games

z Amount: amount of time spent playing video

games

z Content: e.g. violence, educational, sexualcontent, etc.

z Form: formal features that define video gameplay, including aspects of video game design

z Mechanics: game controllers are similar tocontrols in other domains i.e. playing drivingsimulators with a steering wheel should transfer

better than playing with a mouse


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Positive EffectsPositive Effects

of Video Games from Previous Studiesof Video Games from Previous Studiesz Early Studies evaluated psychomotor skills

vs. survey review of Video Game activity

Video gamers showed:

z superior eye-hand coordination1

z faster reaction times2

z superior spatial visualization skills3

z increased capacity for visual attention andspatial distribution4

1. Griffith, Voloschin, Gibb, Bailey; Perceptual and Motor Skills,1983

2. Yuji H; Perceptual and Motor Skills, 19963. Dorval, Pepin; Perceptual and Motor Skills, 1986

4. Green, Bavelier;Nature, 2003


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HypothesesHypotheses

z

Surgeons with past video game experiencewill perform better in a standardized

laparoscopic skill and suturing program

z Video games are correlated with better

performance in a standardized laparoscopicskill and suturing program


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Methods and MaterialsMethods and Materials

z 33 Surgeons (21 residents and 12

attending physicians) participated in thisstudy at Beth Israel Medical Center in

New York City from May-August of 2003

z

The study design centered around TheRosser Top Gun laparoscopic skills and

suturing program


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DemographicsDemographics

3 / 30Dominant hand (raw: left / right)

22 / 2 / 9

Specialty (General surgery /

Urology / OB-Gyn)

239 / 46Number of Laparoscopic cases

(average: Attending / Resident)

12.9 / 3.1Years of Experience in Surgery(Attending/Resident)

12 / 21Attending/Resident

* Male/Female 15/18


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Methods and MaterialsMethods and Materialsz The goal of the Top Gun course is to establish a

fundamental skill set in the laparoscopic arena andteach surgeons to place intracorporeal sutures

z This program has a large data base of thousands ofsurgeons from around the world

z It uses an inanimate electronic proctor thatcontrols for economy of movement errors inaddition to time

z Preparatory drills can establish a skill set whichcan lead to more effective laparoscopic suturing

capabilities


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This study consisted of three elements

all subjects participated in each one

Methods and MaterialsMethods and Materials


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Element one:Element one: QuestionnairesQuestionnaires

z Video game play

z Surgical specialtyz Years of Surgery

experiencez Number of Laparoscopic

cases

z Sex

z Hand Dominance


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Element Two:Element Two: Top GunTop Gun

Laparoscopic Skill and SuturingLaparoscopic Skill and SuturingProgramProgram

Preparatory drills Terrible triangle

Cobra rope Slam Dunk

Clinical Tasks

Intracorporeal suturing


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Drill GoalsDrill Goals

The drills emphasized: Non-dominant hand dexterity

Two-handed choreography Targeting

2-D Depth Perception skills


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Element Three:Element Three:

Video GamesVideo Games

Games were chosen based on

perceived correlation withlaparoscopic skills and suturing

Fine motor skills/Reaction time Eye-hand coordination

Non-dominant hand dexterity

Two-handed choreography

Targeting

2-D depth perception compensation


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Element Three:Element Three:

Video game tasksVideo game tasks

Other Factors: Novel

Lack of bonus scores

Gender neutral


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RESULTSRESULTS

C G


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Current GamersCurrent Gamers

vs. Nonvs. Non--GamersGamersz Top Gun scores

expressed as total time the lower the score

the better

z Current Video-Gamersscored 40% better

overall in the Top Gun

suturing course

(p


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Past Video Game ExperiencePast Video Game Experience

and Suturing Skilland Suturing Skillz Surgeons who have

played video games in

the past were 33% better

at laparoscopic drills

and suturing (p3 hoursper week were 42%

better at laparoscopic

drills and suturing(p 3 hours

(n=9)

0-3 hours

(n=9)

Never (n=15)

Hours/week playing video games (peak)

AverageTopgunScore

* Analysis of variance (ANOVA)


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CorrelationsCorrelations

z With multiple factors

considered, only current

demonstrated video gameskill (p < 0.001)* and

past experience with

video games (p < 0.01)*

were correlated with

proficiency atlaparoscopic drills and

suturing

Correlations

0.64

0.46

0.24 0.21

0.13

0.07

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

VGskill

VGplay Sex

Dom

Hand

#of

cases

Yrsof

training

r

value

*Pearsons correlation coefficient


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Total Errors and Past VideoTotal Errors and Past Video

Game PlayGame Playz If subjects played

video games for > 3hours per week,

they had 37% fewererrors than those

who never played

(p 3 hours/wk 0-3 hours Never

Errors

*Analysis of Variance (ANOVA)


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Total Time and Past VideoTotal Time and Past Video

Game PlayGame Playz If subjects played

video games formore than 3 hours

per week, they were27% faster at

laparoscopic drills

and suturing tasks(p 3 hours/wk 0-3 hours Never

Errors

*Analysis of Variance (ANOVA)


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Regression AnalysisRegression Analysis

Video game skilland past experience

with video gamesare significantpredictors of

laparoscopic skillsand suturingcapability aftercontrolling for sex,years of medicaltraining and # oflaparoscopic casesperformed (p


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NeuroPhysiologyNeuroPhysiology

z During video game play,there are substantial

increases in Dopaminerelease in the striatum andprefrontal cortex - areasassociated with eye-handcoordination1

z Dopaminergic

neurotransmission is alsoinvolved in learning,reinforcement of behavior,

and attention1

1. Donkelaar, Lee, Drew;Human Movement Science, 2002


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z EEG studies have shown thatpractice of any task yieldsefficiency suggesting neuralreorganization that

accompanies skill acquisition1

z This indicates that many areas

of the brain involved in task-related activation are notstable1

1. Smith, McEvoy, Gevins; Cognitive Brain Research, 1999


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z With significant video

game play neural pathwaysmay develop such that eye-

hand coordination and

visual depth perceptionskills are honed and then

later available for skills

development similar tothose show-cased during

the Top Gun and

laparoscopic surgery

Advantages of using videoAdvantages of using video


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Advantages of using videoAdvantages of using video

games in surgical traininggames in surgical trainingz Cost effective platform

of training and skilldevelopment

z Wide availability and

portability

z Future physician

recruitment ofGenerations X and Y

z Error prevention and

reduction implications


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Future DirectionFuture Direction

z Using video games to

warm-up before

minimally invasive

surgical procedures

z

Surgery specific videogame development


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Are Video Game PlayersAre Video Game PlayersBetter at LaparoscopicBetter at Laparoscopic

Surgical Tasks?Surgical Tasks?

James C. Rosser Jr. MD1, Paul J. Lynch MD1,2

Laury A. Haskamp BS3, Asaf Yalif MD1, DouglasA. Gentile PhD4,5, Liza Giammaria MD, MPH1

1. Beth Israel Medical Center, 2. NYU Medical Center, 3. Albert Einstein College of Medicine, 4. Iowa State

University, 5. National Institute on Media and the Family

Di iDi i


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DiscussionDiscussion

z Initially, it is somewhatsurprising that laparoscopic

experience is not more highlycorrelated with Top Gunscores

z And that video games are abetter predictor of intra-corporeal suturing ability

z Possibly due to the fact thatmany laparoscopic surgeriesdo not require advanced

techniques

Wh Vid GWh Vid G


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Why are Video GameWhy are Video Game

Simulators Important?Simulators Important?z Performance of a

specific task has beenshown to improve

with video game-likesimulators

Driving1

Flying airplanes Golf2

1. Walter, Vetter, Grothe, Wunderlich, Hahn, Spitzer;Neuroreport, 2001

2. Fery, Ponserre;Ergonomics, 2001

Wh lt ti t t diti lWhy alternatives to traditional


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Why alternatives to traditionalWhy alternatives to traditional

training models are necessarytraining models are necessary

Follow examples set by the US military, theairline industry and the aerospace industry

z Error prevention

z Cost effectiveness

z Eliminate ethical issues surrounding use of

live animal modelsz Embrace and incorporate new technology

N Ph i lN Ph i l


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z Dopamine release

during video gameplay is involved in

establishing learningpathways that are

further enhanced by

practice.

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Are Video Game Players Better at Laparoscopic Surgical Tasks?