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Background:   Performing minimally invasive surgery requires training and visual-spatial intelligence. The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices.Methods:   A total of 40 medical students randomly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator (SimSurgery®, Oslo, Norway). The variables time and tip trajectory (total path length of the instrument tip trajectory) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model. The experimental group completed additional mental practice during the interval between the two training sessions. All performed a cube subtest of a standard intelligence test (I-S-T 2000 R) to evaluate visual-spatial ability.Results:   All participants achieved an improvement in time ( t = 9.861; p &lt; 0.001) and tip trajectory ( t = 6.833; p &lt; 0.001) in the second training session. High scores on the visual-spatial test correlated with a faster performance ( r = −0.557; p &lt; 0.001) and more precise movements ( r = −0.377; p = 0.016). Comparison of the two groups did not show any statistical significant differences in the parameters time and tip trajectory.Conclusions:   Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices. Additional mental practice did not improve the overall knot-tying performance. Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks.

Impact of Perceptual Ability and Mental Imagery Training on Simulated Laparoscopic Knot-Tying in Surgical Novices Using a Nissen Fundoplication Model