Page 4 - World Journal of Laparoscopic Surgery

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)