Comparison of Correlations of Two Console Based Video Games with Validated MIS Partial Tasks and Intracorporeal Suturing

James Jr. C Rosser, MD, FACS1, Xinwei Liu, BS2. 1Celebration Hospital, 2University of Central Florida, College of Medicine


High costs, lack of realism, and poor participant utilization are inherent shortcomings in simulators used for laparoscopic skill training. The use of video games, which can offer engaging and entertaining properties, could change the way surgeons and surgical residents learn and perform. Underground, a video game for the Nintendo Wii U video game console was designed to simulate laparoscopic tasks through innovative controllers that simulate laparoscopic graspers. This abstract profiles the comparison of correlations between previously validated Super Monkey Ball and recently introduced Underground video game to multiple validated tasks used for developing basic and advanced laparoscopic skills.


Sixty-eight participants, 53 residents and 15 attendings (49 men and 19 women) with a mean age of 35 years and a mean experience of 3 years (SD=3.0) and an average of 444 cases (SD=942) performed both Super Monkey Ball and Underground exercises. In Super Monkey Ball, the player used a small thumb joystick to tilt through various levels as the monkey in a ball rolls around a tilting tract. In the game Underground, players used the Wii console and modified Wii Remotes (designed to simulate laparoscopic graspers) to move two robotic arms to manipulate the environment. The other tasks evaluated included FLS Peg Pass, Pea Drop Drill, and intracorporeal suturing.


Spearman’s Rank correlations were conducted looking at performance scores of Super Monkey Ball, and Underground video games compared to three validated laparoscopic training excercises. The Super Monkey Ball score had a moderate correlation to intracorporeal suturing (rho = 0.39, p < 0.01), and the final score involving all three tasks, (rho = 0.39, p < 0.01), but low correlations to Pea Drop Drill and FLS Peg Transfer (rho = 0.11, 0.18, p < 0.01). The Underground score had very little correlation with intracorporeal suturing and final score (rho = 0.09, 0.13, p < 0.01). However, there were correlations between Underground score and Pea Drop Drill, and FLS Peg Transfer (rho = 0.24, 0.27, p < 0.01, respectively). All data were analyzed using Statistical Package for the Social Sciences (SPSS) and correlations with a value of p < 0.01 were considered significant.


Simulation has been proven to be very helpful in minimally invasive surgical training but accessibility and lack of participant interest have proven to be a hindrance. Super Monkey Ball (SMB) and now Underground (U) offer two validated video game titles that have correlation to laparoscopic skill development and may address both challenges. In this study, SMB had a very significant correlation with the clinical task of intracorporeal suturing. Underground demonstrated more of a correlation with basic skill partial tasks. It is unclear from this study as to the cause of this finding. At this point, our conclusion would be that both are effective for laparoscopic skill training, and they should be used in tandem rather than alone.

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