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ORIGINAL RESEARCH
            Efficacy of Serious Game Training in Comparison with

            the Traditional Training in Learning the Laparoscopic

            Cholecystectomy Skills: An Interventional Analytic Study


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            Zohrehsadat Mirmoghtadaie , Mansour Bhahrdoust , Adnan Tizmaghz , Ghazaal Shabestanipour 4
             AbstrAct
             Background: Performing a laparoscopic cholecystectomy (LC) surgery requires a high level of experience, and complementary training methods
             are demanded. In this study, we evaluated the efficacy of serious game LC training compared to the traditional LC training in laparoscopic
             cholecystectomy skills of junior residents.
             Materials and methods: Forty-four junior residents with no history of LC performance were assigned to either the serious game training group
             (case group, n = 22) or the traditional (Zollinger’s Atlas of Surgical Operations) training group (control group, n = 22). Participants were allowed
             to perform the operation only when they achieved a score of more than 80% in the theory checklist.
             Results: The mean LC skills score based on the pre-surgery theory checklist was 84.5 ± 11.1% in the case group and 68.2 ± 17.6% in the control
             group (p = 0.021). The total number of attempts needed to reach an 80% score in the theory checklist was 2.97 ± 1.40 in the case and 4.17 ± 2.03
             in the control group (p = 0.001). The mean operation time and the number of attempts needed to complete the operation without complications
             were significantly lower in the case group (p = 0.028 and p = 0.041, respectively). The final skills score was 90.8 ± 9.2% in the case group and
             80.1 ± 14.2% in the control group (p = 0.012).
             Conclusion: Serious game training was more effective than traditional training in all aspects of LC performance. Therefore, broader usage of
             the serious game for LC training is recommended.
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             Keywords: Laparoscopic cholecystectomy, Serious game, Touch Surgery .
             World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1523


            IntroductIon
                                                               1 Department of e-Learning, Virtual School of Medical Education and
            Traditionally, surgical learning and teaching are largely based on   Management, Shahid Beheshti University of Medical Sciences, Tehran,
            the use of animals and cadavers. The advent of minimal invasive   Iran
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            surgeries (MIS) has led to decreased surgical morbidity.  Meanwhile,   2 Department  of  Epidemiology,  School  of  Public  Health,  Shahid
            MIS techniques are associated with an increased demand for   Beheshti University of Medical Sciences, Tehran, Iran
            education and training because of a very small workspace and   3 Department of General Surgery, Iran University of Medical Sciences,
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            lack of a direct view of the organs under operation.  Therefore,   Tehran, Iran
            the development of new learning and teaching approaches are   4 Iran University of Medical Sciences, Tehran, Iran
            of considerable value to improve surgical skills such as eye-hand
            coordination in the context of MIS procedures. 1   Corresponding Author: Adnan  Tizmaghz, Department of General
               Laparoscopic cholecystectomy is a widely used MIS technique   Surgery, Iran University of Medical Sciences, Tehran, Iran, Phone: +98
                                                               2164352215, email: adnan_ti@yahoo.com
            that is associated with significant improvement in patient outcomes
            and considerable reduction in the healthcare burden for patients   How to cite this article: Mirmoghtadaie Z, Bhahrdoust M, Tizmaghz A,
                                                               et  al. Efficacy of Serious Game  Training in Comparison with the
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            with biliary tract disease.  Despite these advantages, similar to   Traditional  Training in Learning the Laparoscopic Cholecystectomy
            the other MIS techniques, LC requires a high level of experience   Skills: An Interventional Analytic Study. World J Lap Surg 2022;15(2):
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            to result in satisfactory outcomes.  Therefore, extra education of   99–102.
            surgeons through an attractive alternative way of learning is of   Source of support: Nil
            critical importance.                               Conflict of interest: None
               Currently, training using computer simulation, also known as
            virtual reality (VR) training, is widely used for laparoscopic training
            and has proved to be an effective tool for improving laparoscopic   the trainees, thereby offering a challenging yet motivational
            skills, particularly for those surgical residents who underutilize   opportunity to learn due skills. 5
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            traditional simulation training.  Serious games are referred to the   Touch Surgery™ is considered as a serious gaming mobile
            games with the primary purpose of teaching and learning instead   application designed for surgical training, and its validity for cognitive
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            of entertainment. These innovative VR training applications contain   training and assessment of key LC steps has been demonstrated.
            a high simulation potential for skills that are required for specific   In this study, we evaluate how it affects the clinical skills of surgical
            surgeries. The complex interactive context of serious games engages   assistants when compared with the traditional training modality.



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