Our results suggest that some of the effects of video gaming experience on novice laparoscopy trainees are similar to those of real-world laparoscopy experience on surgeons. We have shown this by using performance and subjective metrics as well as brain activity. To our knowledge this is the first study that includes cognitive and brain metrics, and not just behavioral ones, in the investigation of video game experience in relation to laparoscopy skill, and directly compares these to those obtained from expert surgeons.
Taking novice students with no laparoscopy or gaming experience as a baseline, Fig. 1 shows that task completion time, self-reported cognitive load, and left PFC activation all decreased with increasing gaming experience or with greater laparoscopy experience. Some of these inter-group differences were statistically significant and all followed a clear trend. Furthermore, Fig. 2A shows that within the group of gamer students, students with greater gaming experience completed the training task significantly faster. In previous studies video game playing correlated with better surgical technique in medical school students and impacted the traditional skills of knot tying, incision making and suturing (9). Evidence shows that first-person shooter games preferentially enhance attentional control and executive function(5), however whether a particular genre of video game plays a particular role has yet to be determined in a randomized controlled study. We have not been seen any differences in the effect of genres of game, likely due to insufficient data. In addition to the effect of game playing on performance, we have shown in Fig. 2B that the number of laparoscopy procedures performed in the past may have enhanced surgeons’ task performance.
Figure 3 suggests that there was a significant negative correlation between the cognitive load and gaming experience in students and laparoscopy experience in surgeons. This result it significant since NASA-TLX scores have been shown to independently predict future OR performance (14). In addition higher cognitive load during surgery may lead to distraction, consideration of fewer options than those available, or inflexibility in choosing strategies. Low load on the other hand allows greater amounts of data to be processed, leading to appropriate responses to unexpected events (17).
Figure 1 and Fig. 4 suggest that PFC activation provided that clearest inter-group discrimination, particularly with regard to differences between non-gamer and gamer novices. Comparison of Fig. 4A and Fig. 4B shows that activity in the left PFC, in particular, is reduced as a result of greater gaming or laparoscopy experience. The reduction in activity is consistent with the known dominance of the left hemisphere in motor action regardless of handedness (18), interference processing (19, 20) and overall bi-manual coordination (21, 22). By contrast PFC lateralization is reduced in PTSD and other disorders (23). Previous fNIRS studies of laparoscopy skill have indicated that greater skill is accompanied by behavioral automation, which tends to reduce the engagement of the executive areas in the PFC(24).
Our study had a number of limitations including the following.
Low number of participants. A greater number of participants would allow us to rule out or show the significance of some of the trends observed. It may also reveal the differential effects of the genre of video game.
Student participants did not all play the same set of games. More controlled gaming experience may help increase the accuracy and validity of the results.
Our results show only correlation and not causation. Underlying factor (such as higher dexterity or motivation) could be causing both higher gaming experience as well as better laparoscopy training performance. This shortcoming may be circumvented by an interventional study that manipulates gaming experience systematically.
The quantification of video game experience may have been subject to inaccuracy since it was self-reported. Both in gaming and laparoscopy experience some self-reporting inaccuracy is evident from the fact that there appears to be a bias to report in multiples of fixed values.