Underground was developed by Grendel Games for surgeons to practice their motor skills in a fun and challenging way.

In the game, the player controls a vehicle equipped with two large mechanical arms suited for underground mining operations, such as drilling into large rocks, picking up debris, moving around objects, and welding pieces of scrap metal together.

Underground is one of the many games that fall under the category of Serious Games, where entertainment is used to maintain players’ interest in the subject, especially since players’ interest tend to diminish when the subject is dry. Serious games transfer knowledge, teach skills, create awareness, change behaviour, and increase motivation of its players. Players are able to practice skills through simulations, or games with less realistic environments so long as the correct action is performed.

Previously, the surgeons at the University Medical Center Groningen (UMCG) made little use of the original simulator, despite having to practice an average of 200 hours a year to keep their motor skills up to standard. Practicing in a serious game provides the player with motivation to keep playing, through exciting characters, an imaginative game world, and competition with other players. Serious games make repetitive exercises a lot more enjoyable, making the player more intrinsically motivated to practice for a long time. Surgeons can practice using a laparoscopic controller that allows them to control the game using motions identical to those performed during laparoscopic surgery.

Underground teaches its players laparoscopic skill sets and knowledge in a more engaging manner. By combining game elements and learning strategies, players learn how to solve problems through challenges and rewards in the game. This makes it more appealing than traditional forms of learning and mediums knowledge is presented in.

Despite being a laparoscopic training tool, Underground has no official way of tracking the performance metrics related to laparoscopic surgery skills. It would have been better if players using the game for laparoscopic surgery practice could monitor their performance, and whether they have improved throughout their time practicing on the game.

Source credits:
http://undergroundthegame.com/press/
https://www.undergroundthegame.com/product/underground-controller/
https://www.nintendolife.com/news/2015/09/video_this_laparoscopic_wii_u_controller_is_teaching_medical_students_to_perform_keyhole_surgery