ID: 807 (Conflict of Interest: K)

Serious Gaming und virtuelle Realität im multimodalen Training der Minimalinvasiven Chirurgie: eine randomisierte crossover Studie und Validierung des Trainings der laparoskopischen Leistenhernienoperation

E.Willuth, F.Lang, C.Haney, E. A.Felinska, K.-F.Kowalewski, M. W.Schmidt, B. P.Müller-Stich, F.Nickel
Chirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg


For a good surgical outcome, specific knowledge about the anatomy and the individual steps of operations are indispensable. New learning materials are constantly being developed for this purpose and to ensure the best possible training for surgeons. The research in surgical teaching examines the effectiveness and benefits of these multimodal training settings. The aim of this study was to assess the transferability of surgical skills between the laparoscopic hernia module on the serious game TouchSurgeryTM(TS) and on the virtual reality (VR) trainer LapMentorTM. Additionally, a validation of the laparoscopic hernia repair on TS is foreseen.


Material und Methoden

This was a prospective monocentric randomized cross-over study in the training center of minimally invasive surgery. It was conducted within a voluntary elective module for medical students in their 3rd to 6th year of medical school at Heidelberg University (n=40). All participants were randomized in a 1:1 ratio and stratified by gender to group 1 and group 2. Group 1 started with the “Laparoscopic Inguinal Hernia Module” on TS (phase 1: patient preparation, phase 2: hernia repair) and performed the module first in training mode, then in test mode until proficiency goals were reached. Group 2 started with the “Inguinal Hernia Module” on a VR trainer (task 1: anatomical identification, task 2: incision and dissection) and also performed the module until proficiency goals were reached. Once the goals reached, the groups changed and performed the other training modality until proficiency goals were reached. Primary endpoints were the number of attempts needed to achieve the goals for each group and for each task/phase on both tools. The outcomes were statistically tested using a chi-squared test. P-value under 0.05 was deemed to be significant.


Students who performed on TS first needed significantly less attempts to reach the predefined goal for task 1 on the VR trainer than students who directly started with the VR trainer (TS = 2.70 ± 0.57 vs VR = 3.16 ± 0.69; p = 0.031). No significant differences for task 2 were observed between the groups (TS = 2.25 ± 1.12 vs VR = 2.05 ± 0.85; p = 0.537). For both phases on TS no significant skill transfer from the VR trainer to TS was observed. 


The results show that surgical skills could be transferred from TS to the VR trainer for task 1 but not for task 2. In fact, TS provides only theoretical training and task 1 tests anatomical knowledge, task 2 tests practical skills. Skill transfer from the VR trainer to TS as we expected could not be shown, as the module on the VR trainer teaches purely practical knowledge about the procedure. Also, the VR trainer teaches only the peritoneal preparation (net placement is still under development) and does not teach patient preparation. VR and TS should thus be used in combination in multimodal training to ensure optimal training conditions.