We read with interest the article by Sunter et al. examining the association between video game experience and self-reported surgical technique preferences among general surgeons in Türkiye.1 It is commendable that the authors have set out to discuss a new and increasingly topical issue, especially at the time when the field of minimally invasive and robotic surgery is growing. The study's nationwide approach and focus on practicing surgeons add valuable insight to the evolving discussion on factors influencing surgical practice. Nevertheless, along with these strengths, several important limitations are also worth discussing. First, this study does not have a fully validated survey instrument. Although the questionnaire underwent basic content review and pilot testing, no traces of formal psychometric validation test are found, including the evaluation of the construct validity, or testing the reliability.2 This raises concerns on the precision and reliability of the measures of such constructs as surgical preference and perceived difficulty. Unvalidated instruments have been known to cause measurement bias and compromise the validity of study outcomes.3 Further research must utilise rigorously validated instruments or create questionnaires in accordance with standard psychometric methods, such as factor analysis and internal consistency validation. Second, the study lacks the reporting of response rate and sampling frame to determine the non-response bias. The information is lacking, and therefore, it is not clear whether the sample used in the study is representative of the overall population of general surgeons. This can create systematic bias when there were those individuals with special interest in video gaming or in minimally invasive surgery who were more likely to participate. Non-response bias is also induced when the respondents are different in such a way as to systematically not equal to non-respondents, and this may mislead prevalence estimates and associations.4 It is impossible to assess representativeness when the response rates are low or not reported at all, which raises the risk of systematic bias.5 Therefore, studies are supposed to provide the response rate, the differences between the responders and non-respondents, and possible statistical corrections to enhance representativeness. Finally, the research oversimplifies video game exposure into general groups like yes/no and hours per week but it does not take into consideration the amount of exposure in the lifetime, level of skill, and depth of engagement. Such a narrow description can lead to exposure and misclassification and blur possible dose response relationships. It is indicated that the cognitive and perceptual advantages of gaming also differ notably in intensity, competence and nature of interaction.6 For example, action video games show stronger improvements in attentional and perceptual skills with higher weekly exposure and more advanced skill levels.7 Therefore, more detailed measures of gaming exposure, such as cumulative time, degree of expertise and gameplay type, are also suggested to be considered. Finally, although this study offers some excellent initial findings regarding the possible correlation between video game experience and surgical preferences, the methodological limitations can potentially compromise the validity and generalisability of the presented findings. It will be necessary to address these issues in the future by means of conducting more rigorous studies with objective outcome measures to clarify the real effect of video gaming on the surgical practice and training. All the authors meet the ICMJE authorship criteria and have made significant and equal contributions to this manuscript. All authors approved the final version and agree to be accountable for all aspects of the work, ensuring the accuracy and integrity of the data and interpretation. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing does not apply to this article as no datasets were generated during the current study; all data were sourced from published literature.
Hussain et al. (Sun,) studied this question.