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An Interventional Analytic Study
            Table 1: Comparison of the baseline characteristic features between the two study groups
                                                                     Group
             Variable                        Serious game LC education (n = 22)  Traditional LC education (n = 22)   p-value
             Age (year)                              29.75 ± 6.11                30.46 ± 4.8            0.89
             Sex
               Male                                    18 (81.8%)                 17 (77.2%)            0.12
               Female                                   4 (18.2%)                  5 (22.8%)
             History of participation or laparoscopic   1.92 ± 1.2                 2.21 ± 1.4           0.65
             surgery (number)
             Watching training videos before surgery     19.2 ± 8.30               21.3 ± 6.8           0.58
             (min/day)
             Experience in using computer games and     43.18 ± 20.84              45.11 ± 26.11        0.54
             educational, social networks (min/day)
            Data are presented as mean ± SD or number (%). p <0.05 is considered significant. LC, laparoscopic cholecystectomy

            MAterIAls And Methods                              of the participants. This surgeon also scored the performance of
                                                               participants, in addition to recording the duration and accuracy
            This interventional analytical study was approved by the Review   of performing different stages of surgery without asking for help.
            Board of our institute. Participants were general surgery residents   The performance was checked using the same checklist that was
            of the two educational hospitals in their second years of clinical   designed for checking the participants’ competency to perform
            education. Detailed information about the study design and   LC. The final scores were compared between the participants of
            purpose was provided for all participants. The residents were   the serious game training group and the traditional training group.
            included if they had never been in the LC operating room. The
            residents of one hospital were randomly assigned into the serious   Statistical Analysis
            game LC training group (n = 22), and the residents of the other   We used SPSS for Windows version 16 (SPSS Inc., Chicago, IL, USA)
            hospital were included in the traditional LC training group (n = 22).   for statistical evaluations. Descriptive data were presented with the
            Group matching was performed for age, sex, last promotion score,   mean ± standard deviation (SD) or number and percentage. The
            experience in using computer games, educational social networks,   Shapiro–Wilk test was used to evaluate the normality of distribution.
            and history of participation in laparoscopic surgery variables   A comparison of the mean difference between the two study
            between the two groups. Normally, there was no communication   groups was made with an independent t-test or its nonparametric
            between the residents of the two hospitals.        counterpart (Mann–Whitney U test). Correlation between the
            Serious Game Design and Implication                variables was checked with a Pearson’s or Spearman’s correlation
            The serious LC game was checked by nine professors of general   coefficient test. A p <0.05 was considered statistically significant.
            surgery and laparoscopy and corrected according to their
            suggestions. Then, the game was installed on the dedicated tablets   results
            and delivered to the participants of the serious game group the   The two study groups were not significantly different in the
            day before the surgery.                            baseline characteristic features, including age, gender, history
                                                               of participation or laparoscopic surgery, and experience of using
            Measurements                                       computer games and educational, and social networks (Table 1).
            On the day of the surgery, first, the amount of time and the number   Laparoscopic cholecystectomy skills score based on the pre-
            of times that the participants successfully completed all stages of   surgery theory test was 84.5 ± 11.1% in the serious game training
            the game were extracted from the game software memory and   group and 68.2 ± 17.6% in the traditional training group (p = 0.021).
            recorded in the checklist. In the next step, we asked the participants   The total number of attempts needed to reach an 80% score in
            to express the steps of surgery in theory, and the result was entered   theory checklist was 2.97 ± 1.40 in the serious game training group
            in the checklist designed by the nine involved professors of general   and 4.17 ± 2.03 in the traditional training group (p = 0.001). The total
            surgery and laparoscopy. This checklist was designed based on   LC performance score for the first attempt was 61.2 ± 36.2% in the
            the scoring to have the necessary skills to perform different stages   serious game training group and 48.37 ± 14.5 in the traditional
            of surgery and included six main subheadings, including Port   training group (p = 0.021). The mean operation time and the
            insertion and gallbladder exposure, Dissection of Calot’s triangle,   number of attempts needed to complete the operation without
            Critical view of safety, Ligation of cystic duct and artery, Gallbladder   complications were significantly lower in the serious game training
            dissection, and Specimen removal and closure. According to the   group (p = 0.028 and p = 0.041, respectively). The final skills score
            theory checklist, participants were allowed to perform the operation   was 90.8 ± 9.2%in the serious game training group and 80.1 ± 14.2%
            only when they achieved a score of more than 80%. Patients with   in the traditional training group (p = 0.012). Comparison of clinical
            uncomplicated cholelithiasis or simple biliary colic were selected   scores between two study groups is demonstrated in more detail
            based on these criteria: age: 30–45 years, BMI:25–30, and gallstone   in Table 2.
            size ≤1 cm for being operated by the residents of two studied groups.  The mean duration of playing the game was 62.3 ± 41.1 minutes.
               The operation was performed under the supervision of a   The mean obtained score was 69.6 ± 28.2. A significant positive
            senior surgeon who was not informed of the assignment group   correlation was found between the duration of playing the game

            100   World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)
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