SurgerWii-Illustration-WP

SurgerWii | By Jenny Yoon

From growing up playing StarCraft to adopting a special interest in surgery, perhaps it was fate that I was able to participate in a study on the applications of video games as a method of improving surgical skills.

The study is led by Dr. Simon Byrns, an ambitious senior surgical resident working on his Masters in Experimental Surgery through the Clinical Investigator Program. The aim of the study is to determine whether video games can be used to supplement the training of surgeons for minimally invasive surgeries. If Dr. Byrns’ hypothesis is correct, video games could serve as a method for training surgeons as well as identifying surgeons with greater potential.

In addition to a television monitor hooked up to a Nintendo Wii gaming system, Dr. Byrns’ lab was interspersed with an array of innovative technology, including a camera setup mounted to capture and analyze real-time hand movements like those used in surgical procedures. I was then introduced to the opaque laparoscopic toolbox, a device used to simulate laparoscopic surgery. Also referred to as minimally invasive surgery, laparoscopic surgery is completed through a few small incisions rather than a large intrusive incision common in open surgeries. This is made possible through the use of a monitor allowing the surgeon to see inside the patient while manipulating biological tissue. Similarly, using the opaque box, an attached screen allows users to manipulate tools through a keyhole just like a surgeon would.

It was fascinating to learn that my hand movements manipulating tools inside the box directly mirrored the movements of a real surgeon. Using the instruments, I entered the box through small key holes about half an inch wide. Once inside, I had to pick up pegs one at a time and transfer them from one set of forceps to another and then place the peg down in the right location. I dropped the peg a few times, but I eventually finished the procedure. Keep in mind that like a surgeon, I could not see inside the operation area. The tasks were to be completed with the aid of the television monitor and required immense concentration and precision.

After I completed the surgical task, I proceeded to boot up the Nintendo Wii and play Super Monkey Ball, a game where you control a character using the Wii remote and collect bananas. Using the Wii remote, I found the hand motions used to control Monkey Ball’s character similar to those required to complete the laparoscopic tasks, as they both involved physically manipulating a tool and viewing the results on a screen. One of the mini-games involved shooting down asteroids flying towards me. Although initially this may seem far off from the expertise required to complete a successful surgery, it involves similar skills. Aiming at a target and using the Wii remote to move an object requires strong hand-eye coordination and steady, controlled hand movements. In addition, the game provides immediate feedback. Gauging how much motion is required to move the cursor on screen is similar to evaluating the amount of motion required to move surgical tools within the body. Over two weeks and six sessions with Dr. Byrns, I played Super Monkey Ball for a total of three hours. The idea was to make myself more familiar with the Wii remote and the hand motions required to manipulate virtual objects on screen. Furthermore, I would be given a second attempt at the same laparoscopic task I had completed at the beginning of the experiment to see if my time with Super Monkey Ball had a meaningful improvement on my surgical skills.

On the second attempt, I found that the laparoscopic tasks seemed much easier. I was more comfortable and confident handling the instruments and felt more in control of my hand movements. I was able to complete the task faster and I didn’t drop the peg this time! Fascinated by my apparent improvement, I investigated the use of video games for training real surgeons.  Now a master of operating the Wii remote, I was curious to see what the rest of the scientific community thought about the implications of the Wii beyond just catching pixelated bananas.

On the surface, the application of video games for surgical training makes a lot of sense. With the ever growing popularity of video games, it’s an activity most students have experience with. Video game-led surgical training would utilize knowledge and skills students already possess and apply them to learning a new set of similar skills in a novel environment. As Dr. Byrns explains, “Laparoscopic surgery requires manipulation tools while interpreting visual information through a monitor, which is what you do playing a video game.”

In addition to the traditional laparoscopic training boxes, video games could be used to supplement surgical education. Other studies have shown that video games may serve as preoperative warm-up for surgeons, significantly improving their performance during operations (1). Another study by Plerhoples et al. used Monkey Ball to show that even novices make fewer errors in laparoscopic tasks after playing the video game on their phone for ten minutes (2). During my research on the topic, I also came across other surgery simulation games such as Quiro, which allows you to practice and develop laparoscopic skills on your phone. After completing a few tasks myself, I could appreciate how Quiro and similar applications could be helpful in developing spatial visualization and awareness. Virtual reality games have also been increasingly studied (3), as the platform is becoming more mainstream. The platforms for surgical training continue to evolve through research and innovation.

The Monkey Ball study led by Dr. Byrns also has implications for identifying those who have the aptitude to become good surgeons. Preliminary analysis of performance on the Nintendo Wii demonstrated that most people start at a low level then reach their maximum performance by the end of their session. The steepness of the learning curve could then be utilized to gauge how one will do on the final laparoscopic task. “It could be used to determine whether someone would be appropriate for a career in surgery,” says Dr. Byrns. Interestingly, a study published in 2007 found that video game performance was a better predictor of laparaoscopic skills than years of training (4).  In addition, I learned from my conversation with Dr. Byrns that the mark of a good surgeon is not whether you have steady hands, but “your decision-making and ability to manipulate tools.”

Currently, there is no definitive consensus on the effectiveness of video games as a training platform for surgeons.  While some studies have suggested that those who play video games perform better, others suggest that video gamers actually perform worse compared to non-gamers. However, with passionate and curious researchers like Dr. Byrns contributing to the body of literature, perhaps we may be able to reach a conclusion on the subject. Dr. Byrns’ research marks important progress in the field, possibly influencing how future surgeons could be trained. If video games prove to be an effective way to train and choose surgeons, it could have remarkable implications on improving surgical times and reducing complications. Personally, until there is a consensus in the scientific community, I don’t mind continuing to pwn noobs online in the hopes that it will not only make me a better gamer, but also perhaps a better surgeon in the future.

References:

  1. Jalink, M., Heineman, E., Pierie, J., & ten Cate Hoedemaker, H. (2015). The effect of a preoperative warm-up with a custom-made Nintendo video game on the performance of laparoscopic surgeons. Surgical Endoscopy, 29(8), 2284-2290. doi:10.1007/s00464-014-3943-6
  2. Plerhoples TA, Zak Y, Hernandez-Boussard T, Lau J (2011) Another use of the mobile device: warm-up for laparoscopic surgery. J Surg Res 170(2):185–188
  3. Willis, R. E., Gomez, P. P., Ivatury, S. J., Mitra, H. S., & Van Sickle, K. R. (2014). Virtual reality simulators: valuable surgical skills trainers or video games?. Journal Of Surgical Education, 71(3), 426-433. doi:10.1016/j.jsurg.2013.11.003
  4. Rosser JC, Jr, Lynch PJ, Cuddihy L, Gentile DA, Klonsky J, Merrell R. The Impact of Video Games on Training Surgeons in the 21st Century. Arch Surg. 2007;142(2):181-186. doi:10.1001/archsurg.142.2.181.

Banner Design and Pull Quote Design by Wanderer Online Design Editor Janelle Holod; photography by Wanderer Online Photography Editor Bryan Tran. Wiimote image taken by Evan-Amos as a part of Vanamo Media, which creates public domain works for educational purposes. Surgical Instruments photo taken by Wikimedia Commons user Retama.

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