Surgical Endoscopy (2018) 32:3192–3199
Saving robots improves laparoscopic performance: transfer of skills
from a serious game to a virtual reality simulator
Wouter M. IJgosse
· Harry van Goor
· Jan‑Maarten Luursema
Received: 12 June 2017 / Accepted: 3 January 2018 / Published online: 18 January 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background Residents ﬁnd it hard to commit to structural laparoscopic skills training. Serious gaming has been proposed as
a solution on the premise that it is eﬀective and more motivating than traditional simulation. We establish construct validity
for the laparoscopic serious game Underground by comparing laparoscopic simulator performance for a control group and
an Underground training group.
Methods A four-session laparoscopic basic skills course is part of the medical master students surgical internship at the
Radboud University Medical Centre. Four cohorts, representing 107 participants, were assigned to either the Underground
group or the control group. The control group trained on the FLS video trainer and the LapSim virtual reality simulator for
four sessions. The Underground group played Underground for three sessions followed by a transfer session on the FLS video
trainer and the LapSim. To assess the eﬀect of engaging in serious gameplay on performance on two validated laparoscopic
simulators, initial performance on the FLS video trainer and the LapSim was compared between the control group (ﬁrst
session) and the Underground group (fourth session).
Results We chose task duration as a proxy for laparoscopic performance. The Underground group outperformed the control
group on all three LapSim tasks: Camera navigation F(1) = 12.71, p < .01; Instrument navigation F(1) = 8.04, p < .01; and
Coordination F(1) = 6.36, p = .01. There was no signiﬁcant eﬀect of playing Underground for performance on the FLS video
trainer Peg Transfer task, F(1) = 0.28, p = .60.
Conclusions We demonstrated skills transfer between a serious game and validated laparoscopic simulator technology.
Serious gaming may become a valuable, cost-eﬀective addition to the skillslab, if transfer to the operating room can be
established. Additionally, we discuss sources of transferable skills to help explain our and previous ﬁndings.
Keywords Serious game · Simulation center · Laparoscopy · Skill development · Psychomotor skills · Resident training
Newly immersed in a busy and often unpredictable clinical
environment, residents ﬁnd it hard to commit to structural
laparoscopic skills training in our simulation facilities .
This is aggravated by a lack of oﬃcial standards for certiﬁ-
cation , reduced workweek hours as a result of increased
regulations [3, 4] and limited evidence of transfer to the
operating room . Serious gaming has been proposed as a
way to improve this situation, reasoning that residents like
computer games so much that they will spontaneously start
practising when oﬀered a serious game designed to improve
laparoscopic skills , and that playing a laparoscopic seri-
ous game will help residents develop relevant clinical skills
. We present evidence for transfer of laparoscopic skills
from a serious game to a well-validated virtual reality simu-
lator, establishing construct validity for this game.
and Other Interventional Techniques
Construct validity was investigated for a laparoscopic game by
comparing simulator performance for a gaming group and a
control group. We demonstrated skills transfer between a serious
game and a validated laparoscopic simulator.
* Wouter M. IJgosse
Harry van Goor
Department of Surgery, Radboud University Medical Center,
Geert Grooteplein zuid 10 (route 618), 6525 GA Nijmegen,
Gelderland, The Netherlands
PO Box 9101 (960), 6500 HB Nijmegen, The Netherlands