In the article by Jalink et. al. (2015) titled “Face validity of a Wii U Video Game for Training Basic Laparoscopic Skills”, the authors explore the first ever custom-made video game and hardware for prospective surgeons to teach them basic skills in laparoscopic surgery. I became interested in reading this article because I have always enjoyed simulation games, but I wanted to learn more about how people in their professional lives can use them for training purposes. This goes against what many people think of games – an activity to do to relax and escape reality for a period of time.

According to the authors, surgery students are required to “learn and refine cognitive and psychomotor skills” in order to carry out successful surgeries. Virtual reality simulators are becoming the dominant form of training, as using human and animal models to practice surgical procedures is costly and time consuming. Further, there is evidence that video games can be used to improve basic laparoscopic skills, although no video game specifically made for surgical training has been developed, until now.

A partnership called “Cutting Edge”, formed between the University Medical Center of Groningen (Netherlands), Leeuwarden Institute of Minimally Invasive Surgery, and the company Grendel Games, developed this video game, titled Underground, as well as the corresponding hardware. The developers used the Nintendo Wii-U as the platform for their game. Players use two Wii remote controllers that are also custom made. Although this particular game was custom-designed for surgeons, the game does not include any medical content. Instead, the players are in a fictional world where small robots (controlled by the player) are attempting to escape from a deep mine. The player must control two large robotic arms to destroy and rebuilt the mine. The authors explain why the game designers chose this particular environment:

“The concept of a mine was chosen because laparoscopic surgeons

 also work in a primarily dark area and have to ‘‘break’ things (adhesiolysis, ligation of mesentery, resections) before they can start to ‘‘rebuild’’ (anastomoses, hernia repairs). In the process, the development of a traditional simulator was knowingly avoided and thus does it only serve the purpose of training basic laparoscopic skills (eye–hand coordination, depth perception, inverse movements, and bimanual operation), and is not aimed at teaching anatomy or procedural skills or knowledge.” (Jalink et. al., p. 1103, 2016)

 Illustration of the controller (www.undergroundthegame.com).

The authors studied how users of the game interacted with it and their attitudes about it. They recruited the 72 participants during a Society of American Gastrointestinal and Endoscopic Surgeons meeting. The users participated in a demo of the game and then filled in a questionnaire. In regards to realism, the participants rated the hardware a 7.2 out of 10. The participants rated the game as a serious tool for training purposes as 8.4 out of 10.

My criticism of this particular game is that I feel that the game itself should have included medical content instead of about destroying and rebuilding a mine. However, I can also see how this game as it was designed could be used across multiple subjects that also require fine motor skills. This would allow for different learning experiences across multiple professional fields.

After reading this article, I am wanting to learn more about simulation games in professional fields, particularly games that have custom-made hardware. I was very interested in how they collaborated with Nintendo in order to bring this simulation to the Wii U. Personally, I feel that this is the future of learning and am surprised that custom-made games and hardware aren’t more utilized in professional fields. The one field that it is utilized well in is aviation. I can think of numerous other fields that custom-made simulation games would likely be well-received in or useful.