A serious game to improve situation awareness in laparoscopic surgery

  • Maurits Graafland
  • Marlies P. Schijven

Abstract

Safety analyses show that errors in surgery are more frequently caused by misperceptions and misjudgments than from technical failure of the surgeons. The adaptive coupling between humans and their environment, based on the perception and comprehension of signs and signals when performing a complex task, is referred to as situation awareness (SA). To date, no off-site training methods are offered to improve SA in surgical trainees. To aid the improvement of SA in minimally invasive surgery (MIS), a serious game was designed for surgical trainees. This serious game teaches surgical trainees to deal with major and minor problems in the minimallyinvasive surgical theatre that originate outside of the direct line of sight. Serious games are instructional methods that allow serious skills training in a challenging environment. This paper discusses insights on design, development and evaluation of a game-based educational program for surgical residents.

Keywords

Fatigue Pneumothorax Blindness 

References

  1. 1.
    Klein MI, Warm JS, Riley MA, Matthews G, Doarn C, Donovan JF, et al. Mental workload and stress perceived by novice operators in the laparoscopic and robotic minimally invasive surgical interfaces. J Endourol 2012 Aug;26(8):1089–94.CrossRefGoogle Scholar
  2. 2.
    Zheng B, Rieder E, Cassera MA, Martinec DV, Lee G, Panton ON, et al. Quantifying mental workloads of surgeons performing natural orifice transluminal endoscopic surgery (NOTES) procedures. Surg Endosc 2012 May;26(5):1352–8.CrossRefGoogle Scholar
  3. 3.
    Simons DJ, Rensink RA. Change blindness: past, present, and future. Trends in Cognitive Sciences 2005 Jan;9(1):16–20.CrossRefGoogle Scholar
  4. 4.
    Mack A. Inattentional Blindness: Looking Without Seeing. Current Directions in Psychological Science 2003 Oct 1;12(5):180–4.Google Scholar
  5. 5.
    Fabri PJ, Zayas-Castro JL. Human error, not 2 and systems, underlies surgical complications. Surgery 2008 Oct;144(4):557–63.CrossRefGoogle Scholar
  6. 6.
    Regenbogen SE, Greenberg CC, Studdert DM, Lipsitz SR, Zinner MJ, Gawande AA. Patterns of technical error among surgical malpractice claims: an analysis of strategies to prevent injury to surgical patients. Ann Surg 2007 Nov;246(5):705–11.CrossRefGoogle Scholar
  7. 7.
    Endsley MR. Toward a theory of situation awareness in dynamic systems. Human Factors 1995;37(1):32–64.CrossRefGoogle Scholar
  8. 8.
    Mishra A, Catchpole K, Dale T, McCulloch P. The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy. Surg Endosc 2008 Jan;22(1):68–73.CrossRefGoogle Scholar
  9. 9.
    Endsley MR, Robertson MM. Training for situation awareness in individuals and teams. In: Endsley MR, Garland DJ, editors. Situation awareness analysis and measurement.Mahwah, NJ: Lawrence Erlbaum Associates; 2000.Google Scholar
  10. 10.
    Dankelman J, Chmarra MK, Verdaasdonk EG, Stassen LP, Grimbergen CA. Fundamental aspects of learning minimally invasive surgical skills. Minim Invasive Ther Allied Technol 2005;14(4):247–56.CrossRefGoogle Scholar
  11. 11.
    Schijven MP, Bemelman WA. Problems and pitfalls in modern competency-based laparoscopic training. Surg Endosc 2011 Jul;25(7):2159–63.CrossRefGoogle Scholar
  12. 12.
    Thijssen AS, Schijven MP. Contemporary virtual reality laparoscopy simulators: quicksand or solid grounds for assessing surgical trainees? Am J Surg 2010 Apr;199(4):529–41.CrossRefGoogle Scholar
  13. 13.
    Youngblood P, Harter PM, Srivastava S, Moffett S, Heinrichs WL, Dev P. Design, development, and evaluation of an online virtual emergency department for training trauma teams. Simul Healthc 2008;3(3):146–53.CrossRefGoogle Scholar
  14. 14.
    Cowan B, Sabri H, Kapralos B, Porte M, Backstein D, Cristancho S, et al. A serious game for total knee arthroplasty procedure, education and training. Journal of CyberTherapy and Rehabilitation 2010;(3):285–98.Google Scholar
  15. 15.
    de Wit-Zuurendonk L, Oei S. Serious gaming in women’s health care. BJOG 2011 Nov;118(Suppl 3):17–21.Google Scholar
  16. 16.
    Sharp LA. Stealth Learning: unexpected learning opportunities through games. Journal of Instructional Research 2012;1:42–8.CrossRefGoogle Scholar
  17. 17.
    Heinrichs WL, Youngblood P, Harter P, Kusumoto L, Dev P. Training healthcare personnel for mass-casualty incidents in a virtual emergency department: VED II. Prehosp Disaster Med 2010 Sep;25(5):424–32.Google Scholar
  18. 18.
    Knight JF, Carley S, Tregunna B, Jarvis S, Smithies R, De Freitas S, et al. Serious gaming technology in major incident triage training: a pragmatic controlled trial. Resuscitation 2010 Sep;81(9):1175–9.CrossRefGoogle Scholar
  19. 19.
    Kaushik R. Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management. J Minim Access Surg 2010 Jul;6(3):59–65.CrossRefMathSciNetGoogle Scholar
  20. 20.
    Murphy MM, Ng SC, Simons JP, Csikesz NG, Shah SA, Tseng JF. Predictors of major complications after laparoscopic cholecystectomy: surgeon, hospital, or patient? J Am Coll Surg 2010 Jul;211(1):73–80.CrossRefGoogle Scholar
  21. 21.
    Van den Abeele V, De Schutter B, Annema JH, Husson J, Desmet S, Geerts D. From codesign to playtesting: a practical guide for a player-centered design process [Dutch]. Louvain: Groep T Leuven Engineering College; 2009.Google Scholar
  22. 22.
    Youngblood P, Dev P. A framework for evaluating new learning technologies in medicine. AMIA Annu Symp Proc 2005;1163.Google Scholar
  23. 23.
    Gallagher AG, Ritter EM, Satava RM. Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc 2003 Oct;17(10):1525–9.CrossRefGoogle Scholar
  24. 24.
    Schijven MP, Jakimowicz JJ. Validation of virtual reality simulators: Key to the successful integration of a novel teaching technology into minimal access surgery. Minim Invasive Ther Allied Technol 2005;14(4):244–6.CrossRefGoogle Scholar
  25. 25.
    Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med 2006 Feb;119(2):166–16.Google Scholar
  26. 26.
    Roberts KE, Bell RL, Duffy AJ. Evolution of surgical skills training. World J Gastroenterol 2006 May 28;12(20):3219–24.Google Scholar

Copyright information

© Springer Fachmedien Wiesbaden 2013

Authors and Affiliations

  • Maurits Graafland
    • 1
  • Marlies P. Schijven
    • 1
  1. 1.Department of SurgeryAcademic Medical CentreAmsterdamThe Netherlands

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