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Editorial AUGUST 2006
Video Games,
Sports, and the
Art of Surgery
Arnold P. Advincula, MD
At first glance, the title of this editorial may seem a bit odd.
However, as director of minimally invasive surgery at the University
of Michigan, Ann Arbor, I am always looking for ways to creatively
teach the art of gynecologic surgery. So how could video games,
sports, and the art of surgery be in any way related? Surprisingly,
the relationship is closer than one would think.
Let us start with video games. As a child of the '80s,
I grew up with Atari and Nintendo. My parents always gave me grief
for spending too much time in front of the television playing video
games. Well, I may be seeing the fruits of these "misspent" hours
in my work today. According to researchers at the National Institute
on Media and the Family,1 good
video game skills translate into surgical prowess. They discovered
that surgeons who spent at least
3 hours per week playing video games made about 37% fewer mistakes
in laparoscopic surgery, and performed the task 27% faster than
their counterparts who did not play video games. Overall, surgery
and in particular laparoscopy requires the same motor skills, reaction
time, and hand-eye coordination that are involved in playing video
games. In essence, video games are part of the burgeoning field
of surgical simulation. Surgeons can now practice their techniques—or
even the actual planned surgery—through video simulation.
Indeed, Dr Rosser has incorporated his findings into a "Top
Gun" program that provides a video game "warm-up" for
surgical residents before they enter the operating room.
The concept of a warm-up certainly makes sense. For example, basketball
players routinely take the court for a pregame warm-up. They dribble
the ball and take shots at the basket, stretching their muscles
and calibrating their shooting eye and “feel” for the
ball prior to the game. By contrast, surgeons typically roll out
of bed for early-morning rounds followed by a stint in the operating
room. Nowhere in this schedule is there a routine warm-up for their
surgical skills. Based on Dr Rosser's work, this is not good practice.
Actually, many sports practices are transferable to the surgical
arena. Another example is the "time-out"—ie,
a short break from work or play. In sports, it signifies an interruption
in play in which officials stop the clock for purposes of rest,
making a substitution, or consultation during a critical part of
the game. As surgeons, we have now adopted this practice prior
to the start of a procedure as the result of a Sentinel Event Alert
issued by the US Joint Commission on Accreditation of Healthcare
Organizations on wrong-site, wrong-procedure, and wrong-person
surgery.2 Unfortunately, it took 15 reported cases of wrong-site
surgery before this policy was implemented. Just as a coach can
bring together a team during a time-out, so can a surgeon use this
pause to promote unity in the operative team. This allows for confirmation
of patient identity, operative side/site, procedure, patient position,
and availability of implements and equipment—a matter of
getting everybody on the same page of the playbook.
In my days as a resident, one of my mentors used to say, "Take
what the defense gives you." As a bright-eyed, budding surgeon,
I wondered how this old football adage applied to gynecologic surgery.
As I matured, I realized that no two cases were the same, so that
a surgeon who approaches a hysterectomy in the same way every time
will never be able to "tackle" the more difficult cases.
In other words, a surgeon must first address the aspects of a given
case that present as easiest; this makes a difficult case more
manageable. That is the art of surgery.
Legendary coach Knute Rockne noted that "Football is a game
played with arms, legs, and shoulders, but mostly from the neck
up." Surgically speaking, physicians can have the most gifted
hands, but cannot achieve technical prowess without common sense
and sound judgment as well. This translates into an understanding
of surgical indications, appropriate procedures, personal limitations,
and potential complications.
Hence, video games, sports, and the art of surgery really are closely interrelated. These lessons have an impact on the patients for whom we care on a daily basis. So I guess that standing at the scrub sink in a warm-up suit and holding a portable video game may not be entirely crazy after all!
Arnold P. Advincula, MD
Associate Editor
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References
- Video game experience and skill good indicator of laparoscopic surgical proficiency [press release]. National Institute on Media and the Family Web site. January 14, 2004. Available at: http://www.mediafamily.org/press/20040114.shtml. Accessed June 14, 2006.
- Lessons learned: wrong site surgery. Sentinel Event Alert. 1998;(6):1-2.
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