Study design and participants
hand gestures
This study was designed as a randomized, controlled two-arm study. The total sample size was 40 trainees. The study was performed as a part of the complementary MIS training curriculum for medical students (trainees) in their clinical years (3rd to 6th year) at Heidelberg University Medical School, Germany. The training was conducted in the MIS training center within the Department for General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Germany. The study was approved by the local ethics committee (S-436/2018).After signing a consent form, the trainees were randomized into two groups. Randomization was performed by an independent employee, otherwise not involved in planning, conducting, or analyzing the study, using a free available randomization tool (Flowchart of the randomized controlled studyAfter performing the baseline LC, each trainee performed 10 LCs within ten training sessions. The trainees within the control group only received verbal guidance, whereas those within the iSurgeon group received verbal and visual guidance using the iSurgeon (Fig. iSurgeon setup during a LC on a box-trainerTutor giving instructions during ex vivo porcine LC to the medical student with hand gestures displayed on the screen