Game-Based Learning and Gamification in Laparoscopic Skills Education: Meta-Analysis and Systematic Review

Gamification, the integration of game elements into education and game-based learning, is increasingly applied to laparoscopic skills training. However, systematic evidence on its effectiveness and practical feasibility remains limited and fragmented.

This study aimed to evaluate the effectiveness and feasibility of gamified interventions and game-based learning in improving laparoscopic skills education.

We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials from January 1, 2000, to July 1, 2026, for studies evaluating gamification and game-based learning in laparoscopic skills education. Eligible studies included interventional and observational studies involving medical students, residents, or surgeons, with measurable performance outcomes. Study quality was assessed using ROBINS-I (Risk of Bias In Non-randomized Studies-of Interventions), RoB 2 (Cochrane Risk of Bias Tool 2), and NIH quality assessment tools. Standardized mean differences (SMDs) were pooled using random-effects models; between-study heterogeneity was quantified by τ² and described by the I² statistic (inconsistency), while the Cochran Q test tested homogeneity. Certainty of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

A total of 39 studies involving 2102 participants were included. Video game-based interventions served mainly as training tools or assessments, whereas gamified contexts incorporated competitive or collaborative motivational elements. Three subgroup meta-analyses were performed. Game-based learning vs no training yielded a pooled Hedges g of -0.04 (95% CI -7.14 to 7.06; I²=96.7%; 95% prediction interval -13.95 to 13.61), game-based learning vs conventional laparoscopic training yielded 0.49 (95% CI -1.39 to 2.36; I²=79.4%; prediction interval -3.60 to 4.51), and gamified vs nongamified training yielded 0.87 (95% CI -5.08 to 6.81; I²=61.6%). None of the 3 comparisons reached statistical significance, and all prediction intervals crossed the null, indicating that true effects may range from beneficial to harmful across settings. Risk of bias was mostly moderate, and certainty of evidence ranged from very low to moderate. Leave-one-out analysis showed that pooled estimates in the first 2 subgroups were driven largely by individual studies and were not robust.

Both game-based learning and gamified contexts are feasible adjuncts for basic laparoscopic skills training and may enhance motivation and deliberate practice; however, meta-analytic evidence did not demonstrate a statistically significant advantage over no training or conventional laparoscopic training, and the results were not robust to leave-one-out analysis. Generic video games showed limited efficacy for advanced, procedure-specific skills, and the evidence is constrained by heterogeneous outcome measures, small numbers of studies, moderate risk of bias, and a lack of long-term follow-up. As the first synthesis to compare video game-based and gamified context-based approaches within a unified framework, this review provides educators with guidance for integrating task-aligned gamified modules into existing curricula, while highlighting that robust efficacy and sustained operative transfer remain to be demonstrated by larger, standardized studies.