1 Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
2 Surgical Artificial Intelligence Research Academy, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
3 Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
4 Gina Cody School of Engineering and Computer Science, Concordia University, Montreal, QC, Canada.
5 Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
6 Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
7 Department of Surgery, Emory University, Atlanta, GA, USA.
8 Surgical Artificial Intelligence Research Academy, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. amin.madani@uhn.ca.
9 Department of Surgery, University of Toronto, Toronto, ON, Canada. amin.madani@uhn.ca.

Background: Gaming can serve as an educational tool to allow trainees to practice surgical decision-making in a low-stakes environment. LapBot is a novel free interactive mobile game application that uses artificial intelligence (AI) to provide players with feedback on safe dissection during laparoscopic cholecystectomy (LC). This study aims to provide validity evidence for this mobile game.

Methods: Trainees and surgeons participated by downloading and playing LapBot on their smartphone. Players were presented with intraoperative LC scenes and required to locate their preferred location of dissection of the hepatocystic triangle. They received immediate accuracy scores and personalized feedback using an AI algorithm ("GoNoGoNet") that identifies safe/dangerous zones of dissection. Player scores were assessed globally and across training experience using non-parametric ANOVA. Three-month questionnaires were administered to assess the educational value of LapBot.

Results: A total of 903 participants from 64 countries played LapBot. As game difficulty increased, average scores (p < 0.0001) and confidence levels (p < 0.0001) decreased significantly. Scores were significantly positively correlated with players' case volume (p = 0.0002) and training level (p = 0.0003). Most agreed that LapBot should be incorporated as an adjunct into training programs (64.1%), as it improved their ability to reflect critically on feedback they receive during LC (47.5%) or while watching others perform LC (57.5%).

Conclusions: Serious games, such as LapBot, can be effective educational tools for deliberate practice and surgical coaching by promoting learner engagement and experiential learning. Our study demonstrates that players' scores were correlated to their level of expertise, and that after playing the game, most players perceived a significant educational value.