Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii

Kellie K. Middleton*, Travis Hamilton, Pei Chien Tsai, Dana B. Middleton, John L. Falcone, Giselle Hamad

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

30 Scopus citations


Background Video games have been shown to improve eye-hand coordination, spatial visualization, manual dexterity, and rapid mental processing, which are important in the acquisition of laparoscopic skills. This study investigated the relationship between playing Nintendo WiiTM and virtual reality (VR) laparoscopic surgery simulator performance. We hypothesized that playing the Wii would improve surgical skills performance on a VR laparoscopic simulator and hoped to elucidate which tasks, in particular, would be most beneficial for nondominant hand training. Methods This was a single-blinded, randomized, prospective study conducted with 23 student volunteers. VR laparoscopic skills were assessed at baseline on a Simbionix LapMentorTM Surgical Simulator (Simbionix Ltd., Israel) and after the gaming period of 2 weeks. Simulator performance metrics were compared between groups using nonparametric statistics and an alpha of 0.05. Results Compared with the control group, the Wii-playing group demonstrated greater improvement of six measures, including accuracy on the eye-hand coordination task (p = 0.04), faster completion time (p = 0.04), decreased number of left-handed movements (p = 0.03), decreased left handed total path length (p = 0.03), decreased total number of grasping attempts (p = 0.04), and improved lefthanded economy of movement (p = 0.05) for the bimanual clipping and grasping task. When comparing the number of measures improved upon by the Wii-playing group and the control group for all three tasks, the Wii-playing group consistently outperformed the control group in 18 measures compared with the control group's improvement in 6. Conclusions This study further characterizes the association between video game playing and surgical performance. Improvements following the intervention were made in the most basic of surgical skills, most notably with the nondominant hand, suggesting that short-term playing of the Wii could improve bimanual dexterity and expedite the acquisition of basic surgical skills.

Original languageEnglish
Pages (from-to)4224-4231
Number of pages8
JournalSurgical Endoscopy
Issue number11
StatePublished - 11 2013
Externally publishedYes


  • Bimanual dexterity
  • Nondominant hand
  • Video games
  • Virtual reality surgical simulator


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