Impact of Perceptual Ability and Mental Imagery Training on Simulated Laparoscopic Knot-Tying in Surgical Novices Using a Nissen Fundoplication Model

BACKGROUND: Performing minimally invasive surgery requires training and visual-spatial intelligence. The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices. METHODS: A total of 40 medical students randomly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator (SimSurgery®, Oslo, Norway). The variables time and tip trajectory (total path length of the instrument tip trajectory) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model. The experimental group completed additional mental practice during the interval between the two training sessions. All performed a cube subtest of a standard intelligence test (I-S-T 2000 R) to evaluate visual-spatial ability. RESULTS: All participants achieved an improvement in time (t = 9.861; p < 0.001) and tip trajectory (t = 6.833; p < 0.001) in the second training session. High scores on the visual-spatial test correlated with a faster performance (r = -0.557; p < 0.001) and more precise movements (r = -0.377; p = 0.016). Comparison of the two groups did not show any statistical significant differences in the parameters time and tip trajectory. CONCLUSIONS: Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices. Additional mental practice did not improve the overall knot-tying performance. Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks.