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An Interventional Analytic Study
            Table 2: Comparison of clinical scores between two study groups
                                                                         Group
             Variable                               Serious game LC training (n = 22)  Traditional LC training (n = 22)  p-value
             Skills score based on the pre-surgery theory test  84.5 ± 11.1           68.2 ± 17.6        0.021
             Number of attempts needed to reach an 80% score
                                                           2.51 ± 1.22               4.11 ± 2.2
                                                             2.8 ± 1.40                3.9 ± 1.9         0.001
                                                           3.61 ± 1.58                4.5 ± 2.01
                                                           2.97 ± 1.40                4.17 ± 2.03
             For the first attempt skill score
                                                           50.1 ± 16.2                43.2 ± 12.1
                                                           66.3 ± 11.1              50.33 ± 13.5         0.021
                                                           67.2 ± 8.9                 51.6 ± 17.6
                                                           61.2 ± 36.2              48.37 ± 14.5
             Speed operation time (m)                       46.5 ± 10.12             63.31 ± 12.25       0.028
             Number of attempts needed to complete the opera-  2.11 ± 0.99           2.81 ± 1.2          0.041
             tion without complications
             Final skills score gained in performing surgery  90.8 ± 9.2              80.1 ± 14.2        0.012
            Data are presented as mean ± SD. p <0.05 is considered significant. LC, laparoscopic cholecystectomy

            Table 3: Correlation between the final skills score and characteristics   their review, all of which reported significant improvement in
            features of the participants                       learning scores following the use of serious games. In 14 out of 18
                                              Pearson          publications with a controlled experiment, post-test scores were
             Variable                        correlation  p-value  significantly higher after serious games training compared to
                                                               the conventional teaching methods. They concluded that health
             Age                               −0.12    0.65   professions training using serious games seems efficacious, at least
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             Sex                                 0.085  0.91   in the short term.  Similarly, the surgical skill score was significantly
                                                               more in the serious game training group of the present study
             History of participation in laparoscopic     0.51    0.029
             surgery                                           compared with the traditional training group.
                                                                  Laparoscopic procedures are acknowledged as a significant
             Experience in using computer games and     0.11  0.59  source of surgical errors, and therefore, demand special training
             educational social networks
                                                               to obtain the required experience. There is an expanding trend in
             Duration of surgery               −0.66     0.001  studies evaluating the efficacy of serious games in laparoscopic
                                                               training. Graafland et al. investigated whether serious game training
                                                               improves residents’ skills to solve equipment-related problems
            and the final skills score (r = 0.061, p = 0.001), as well as between
            the mean obtained score and final skills score (r = 0.87, p = 0.001). A   during laparoscopic surgery. Thirty-one surgical residents without
            significant negative correlation was found between the final skills   laparoscopic experience were randomly assigned into either the
            score and duration of surgery (r = −0.66, p = 0.001). The history of   serious game group (n = 16) or the traditional curriculum. The
            participation in laparoscopic surgery was also positively correlated   laparoscopy task was performed in a pig model, during which
            with the final skills score (r = 0.51, p = 0.029). The correlation of the   three scenarios of standardized equipment malfunction occurred.
            final skills score with the characteristics features of the participants   The serious game group solved more equipment-related problems
                                                                                                 7
            is demonstrated in more detail in Table 3.         than the traditional training group (55 vs 33%).  We did not evaluate
                                                               the skills of residents in solving the equipment malfunctions.
                                                               However, residents of the serious game group outperformed the
            dIscussIon                                         surgery compared to the traditional training group, which was
            In this study, we compared the surgical LC skills between the   demonstrated by a higher final skill score of LC performance.
            residents who were trained via the serious game and those who   Ijgosse et al. evaluated the construct validity of the serious
            were trained traditionally. Based on our results, the serious game   game Underground for laparoscopic skills. The performance
            training group had a higher skill score on the pre-surgical theory   was compared between the novices (less than ten prior
            test, a lower number of attempts needed to reach an 80% skill   laparoscopic experiences), intermediates (10–100 prior laparoscopic
            score, shorter surgical duration, lower number of attempts needed   experiences), and experts (>100 prior laparoscopic experiences).
            to complete the operation without complications, and higher final   Prior laparoscopic experiences showed a significant effect on
            skills score. The final skills score was significantly correlated with   the time variable. The experts and intermediates outperformed
            the duration of serious game playing and the mean obtained score.  novices regarding the speed task. The rate of gameplay errors
               The learning efficacy of serious games for a variety of health   showed a similar trend between different groups. Male gender
            professions education has been evaluated in earlier studies. 7–12    and prior video game experience were associated with better
            Haoran et al. reviewed the studies evaluating the efficacy of serious   performance. Accordingly, the construct validity was established
                                                                                         14
            game training from 1996. A total of 25 studies were included in   for the serious game Underground.  In comparison with traditional

                                                        World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)  101
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