When you’re playing Nintendo you may be learning more than how to control a voracious gorilla, rescue a kidnapped princess or negotiate a go-cart course, according to a new study.

In a study posted online Wednesday in the open access journal PLOS ONE, researchers from the department of surgical sciences at the University of Rome measured the surgical skills of students who trained on a Nintendo Wii.

Across four tasks measuring 16 skill-sets on a simulator, such as locating objects with a camera and photographing them, and touching flashing, colored balls with its corresponding tool, Wii team outshone their traditionally trained colleagues in 13 of them. Dr. Mario indeed!

“Laparoscopic simulators represent a satisfactory response to this request but their high costs have limited their spread,” the study authors wrote. “Video-games may be a cheap and widely available product, helping to develop cognitive skills that, apparently, can be transferred in improved surgical performance.”

Laparoscopic gallbladder removal requires surgeons to remotely operate tools inside the patient’s abdomen, including a fiber-optic camera. Using a surgery simulator, students were graded in four tasks involving camera movement, locating objects, moving objects and completing the procedure.

According to this new study, the students who played on the Wii showed greater efficiency and accuracy in handling surgical tools. The study involved 42 first- and second-year graduates studying general, vascular and endoscopic surgery. Half the group was trained on regular simulators and the other half spent one hour a day, five days a week for four weeks playing on a Wii.

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Surgery residents committed eight times as many errors during simulated procedures when realistic distractions and interruptions were introduced than when they completed procedures without interruption, investigators reported.

The residents made major surgical errors during eight of 18 simulated procedures with distractions versus only one of 18 operations that occurred without intrusions.

Additionally, more than half of the residents forgot a key memory task related to the surgery when they were interrupted as compared with 22% during uninterrupted surgery, as reported online in Archives of Surgery.

"This study provided statistically significant evidence to support the hypothesis that realistic operating-room (OR) distractions and interruptions increase the likelihood of errors in a simulated laboratory setting with novice surgeons," Robin L. Feuerbacher, PhD, of Oregon State University-Cascades in Bend, Ore., and co-authors wrote in conclusion.

"This finding is important because it implies that OR distractions and interruptions may lead to adverse patient outcomes," they added.

Despite the high error rate, the authors said the results should not be interpreted as representative of operating-room (OR) experience in general.

"It must be noted that the distractions and interruptions were timed to occur at critical points and occurred more frequently than observed in an OR," they wrote. "Consequently, these results should not be used to infer that almost half of all surgical procedures with distractions and interruptions are expected to have major surgical errors."

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TORONTO -- It's a pivotal event that comes in the education of all would-be surgeons. At some point, medical students who plan to make a career of opening up and fixing other human beings have to make that first cut.

If Drs. Teodor Grantcharov and Vanessa Palter have their way, however, that first application of scalpel to skin will occur on a computer screen, not on the torso of a living, breathing person. And not just the first cut. They believe surgical residents ought to achieve an established level of proficiency in a virtual operating room before they start plying their scalpel in a real OR.

"There are studies that show that in the first 50 cases, the risk of major complications is significantly higher than after the next 30 cases. And all these studies are done on real patients," says Grantcharov, an associate professor of medicine at the University of Toronto and a surgeon who specializes in minimally invasive procedures at St. Michael's, one of the university's teaching hospitals.

To Grantcharov, the idea of allowing surgical residents to operate before they've met a set skill level in a virtual OR is outdated.
Simulation tools are now available and are found with increasing frequency in medical schools across North America. They provide an alternate route for surgical residents to climb the early -- and risk-filled -- part of the learning curve.

"I always found it ridiculous to talk about learning curves on real patients," says Grantcharov, a towering figure decked out in clogs, scrubs and a Toronto Maple Leafs surgical cap. We want to see the learning curve in the simulation theatre or on the computer. Talking about learning curves of procedures on patients -- I think it's unethical."

And inefficient. Grantcharov and Palter -- a surgical resident who is also working on a PhD -- recently published a study showing that surgical residents who train first in a simulation lab significantly outperform colleagues who receive only standard surgical training.

The study compared University of Toronto surgical residents who completed a five-month long simulation training module to residents who received conventional surgical training. All the residents performed a laparoscopic right hemicolectomy -- an operation where a tumour is removed from the right side of the colon using small incisions, not the large cuts commonly used for operations in the past.

The procedures were videotaped and graded by outside experts. Residents who had trained on the simulators scored an average of 16 points (out of 20) where surgical residents who didn't get the additional virtual training scored an average of eight.

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What's the best way to improve surgical patient safety nationwide? Collaborate. Or so claim the American College of Surgeons (ACS) and Centers for Disease Control and Prevention (CDC), who recently released a plan for a three-year strategic partnership. According to an ACS news release, the alliance will combine knowledge and streamline resources to track, report, and prevent adverse surgical site outcomes, encourage use of technology, and equip practitioners with the tools they need to ensure excellence in healthcare delivery.

Namely, quality of care measures, electronic health record (EHR) systems for data collection and quality measurement, and cutting-edge solutions for surgical training such as clinical simulation technology.

And to help fill knowledge gaps between local care and public health, the alliance plans to engage field experts. Practitioners and surveillance and prevention thought leaders will help the ACS/CDC group categorize what data will be collected, and in what way, to determine how best to maximize safety. They'll also develop measures aimed at preventing infections and complications, ultimately improving patient safety and surgical outcomes.

Clifford Y. Ko, MD, FACS, director of the ACS Division of Research and Optimal Patient Care said in the release, "It's clear that our national health system is seeking better ways to measure quality care."

The ACS and CDC are on the right track – together.

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Memorial Hermann-Texas Medical Center in Houston plans to live tweet brain surgery today. Under the Twitter handle @houstonhospital, the hospital will provide a "rapid play-by-play" removal of a brain tumor for about four hours using the hashtag #MHbrain on Wednesday, May 9 from 7:30 a.m. to 11:30 a.m. CT.

The surgery will be led by Dr. Dong Kim, neurosurgeon and Director of the Mischer Neuroscience Institute in Houston. Dr. Kim was the neurosurgeon who oversaw Rep. Gabrielle Giffords' care at the hospital after she was shot in the head in January 2011.

Medical personnel will live tweet all the steps of the tumor removal procedure, including prep, removal of the bone flap, resection of the brain tumor and closing of the surgical site. In addition to tweets, users will see pictures and videos live via Dr. Kim's microscope video feed. The first incision is expected to start at 9:00 a.m. CT (10:00 a.m. ET).

"What will come out of this is a detailed, real-time sequence of what happens in a brain surgery through all the stages from preparation, to shaving the hair, to making the incision, to draping," Dr. Kim told Mashable. "People are very anxious and want to know what goes on in a brain surgery like this."

Dr. Scott Shepard, a brain tumor specialist at the hospital and Director of the Gamma Knife Radiosurgery program will respond to questions online from outside the operating room during the Twittercast.

Natalie Camarata, Memorial Hermann's digital marketing manager, told Mashable the hospital decided to live tweet brain surgery following a successful live tweeting of open-heart surgery several weeks earlier, which was viewed an estimated 125 million times through Twitter and other platforms.

According to Mashable, video clips from the surgery will be posted to YouTube, photos will be shared on Pinterest, and recaps of each hour of the surgery will be available on Storify.

To find out more, visit Memorial Hermann-Texas Medical Center.

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Although there have been some concerns that patients might suffer from having such doctors in training -- medical school graduates known as residents -- operate on them, the findings show that health problems and death related to surgery were unrelated to the seniority of the surgeon.

"The important thing is to train future surgeons and to make it safe during the process, and it looks like (the hospital in the study) has figured out how to do that," said Dr. Matthew Hutter, a surgeon and the director of the Codman Center for Clinical Effectiveness in Surgery at the Massachusetts General Hospital, who was not involved in this study.

Previous research has looked at the impact of the so-called "July effect" -- the time of year when doctors-in-training begin their residencies.

The fear has been that being admitted to the hospital in July could mean worse care by an inexperienced physician, and while some studies have found evidence for that, others have not (see Reuters Health report of September 14, 2011).

Patients sometimes ask not to be operated on by a resident, said Dr. Leon Graat, a resident surgeon at St. Elisabeth Hospital in Tilberg, The Netherlands, who led the study.

"It made me wonder if residents do underperform or if it is only in the mind of the patient that only experienced doctors can take good care of them," Graat told Reuters Health by email.

'SHOULD HAVE NO HESITATION'

To answer the question, he and his colleagues looked back on the medical records of all patients who had their appendices removed at his hospital between 2000 and 2009.

Appendectomies are useful to study because it is one of the first surgeries performed by residents, Graat said, and at his hospital appendectomies are usually assigned to residents unless one is not available. Surgeons remove more than 320,000 per year in the U.S., according Graat and his co-authors.

Of the more than 1,400 patients included in the study, 23 percent had their appendices removed by a staff surgeon, also called an attending, a doctor who has finished all his or her training.

The rest of the surgeries were performed by residents; half of whom were supervised by a staff surgeon, and the other half were done independently.

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