Endless Thread - Hidden Levels: Surgical Precision (Side Quest)

Episode Date: October 21, 2025

Dr. James "Butch" Rosser was a pioneer in minimally invasive surgery in the 1990s. When he credited his surgical skills to video games, people dismissed him. The prevailing narrative was that kids who played video games became killers, not doctors. So Butch set out on quest: to show how video games can help make better doctors. Show notes: The impact of video games on training surgeons in the 21st century (JAMA Surgery) Study: High-School Video Gamers Match Physicians at Robotic-Surgery Simulation (Slate) We Have to Operate, but Let's Play First (The New York Times) He’s really on his game (Orlando Sentinel) Credits This episode was written and produced by Grace Tatter and edited by Meg Cramer. Mix, sound design and music composition by Emily Jankowski. "Hidden Levels" is a production of 99% Invisible and WBUR's Endless Thread. The Managing Producer for Hidden Levels is Chris Berube. The series was created by Ben Brock Johnson. Series theme by Swan Real and Paul Vaitkus. Series art by Aaron Nestor.

Support for endless thread comes from Mathworks, creator of MATLAB and Simulink Software, to design and develop engineered systems, accelerating the pace of discovery in engineering and science. Learn more at Mathworks.com. Support for this podcast comes from Nature is the Solution, a podcast from the Nature Conservancy. This show tells climate stories like a stubborn optimist, because hope, innovation, and nature itself are key. to solving the challenges ahead. Follow on your favorite podcast app. WBUR Podcasts, Boston.

Ben Brock Johnson. Uh-huh. Amory Seabritson, yeah. Are your fingers magic? Are your hands your greatest asset? I think, I mean, I can tie a double knot, no problem. But if, but, but, and, and I do have. have a double-jointed thumb.

Oh. So that's a thing that's cool about my hands. Oh, yeah. You, like, crack your thumb sometimes, right? You do, like, a weird, like, thumb roll. No, I can just, I got a double-jointed thumb. It just, like, kind of pops in and out. But, like, if you ask me to do anything with a needle and thread, I'm worthless.

You're not even getting the thread through the needle. No, it's tough. It's tough. Tough to thread that needle for these sausage fingers, for sure. Okay. Well, our next exclusive side quest from Hidden Levels, our series with 99% Invisible about how the video game world has changed the world beyond video games, is about a surprising connection that one man has been trying to get the medical community to accept and celebrate for decades now.

And he's got scientific studies to back it up. Next up in our series, Grace Tatter brings us an episode that should make you think twice about the concept that video game. rot your brain. This one's called surgical precision. Grace, we are in your hands. Butch Rosser's quest started before he even set eyes on a video game in the small town where he grew up. Moorhead, Mississippi.

I wanted to be a doctor ever since I was five years old. When he was a kid, Butch's mom got really sick. My mother had a terrible attack of abdominal pain. She was riving around. I thought she was going to die. This was the 1950s. Butch's dad, who was black, called the local doctor, who was white, and asked him to come over. This was a bold thing to do in Jim Crow era, Mississippi.

But on this instance, God somehow touched his heart to come and do a house call on my mom. And he examined her, and I was watching it just attentively. everything he went through with her in the exam and everything. And he said, Marjorie, I think you have a gallblight attack. I have this concoction I've put together for you that should get you better in the next two to three hours. He gave her that and in an hour, she was like nothing had happened. The fact Dr. Philip came impressed me and the fact that he knew what to do and helped my mom, it was a miracle to me. So Butch knew what he wanted to do when he grew up.

He also knew where he wanted to learn how to do it. All of my life, I wanted to go to the University of Mississippi, Ole Miss. Mississippi's flagship university is in Oxford, about 100 miles northeast from Warhead. When Butch was still a kid, James Meredith became the first black student to enroll at the University of Mississippi. Butch remembered hearing about the racism-fueled chaos that met Meredith. The riots were so violent, President Kennedy deployed more than 30,000 troops. Butch enrolled there as a full-time student 10 years after that in 1972, and there still weren't many black students.

But he knew he had the grades to succeed, and he came from a family of trailblazers. He was even willing to give up a football scholarship at the University of Florida to become a Mississippi rebel. Coming from a family, that it's always broken the barrier, whether it be my father, in the Marines, the most segregated branch of the armed forces, to my grandfather, who was a butcher on this plantation and was the first black butcher there. I'm surrounded by people who have a legacy at first and a legacy of believing in more than themselves. That didn't mean it was easy. It's really weird sitting in a chemistry class with 300 people and you're the only person of color in the room.

You need a maximum effort all the time to be able to get through that. Only one person in his organic chemistry class even acknowledged his existence. Everybody else just ostracized me. They saw me, but they didn't see me if that makes any sense. Butch was often totally alone. But then one day he was in the student union. And I heard this sound, boop, boop, boop. I said, what is that sound?

I went over it. And it was the Pong game. You're watching the most exciting game you will ever see on your TV set. When Pong was released by Atari in 1972, it became the first commercially successful video game because it could be played on an at-home gaming console. If you play video games, you've probably heard of Pong. It's essentially virtual table tennis.

A white square bounces back and forth across a black void. A white line represents your paddle. Miss the ball and it disappears off your side of the screen. Your opponent scores. Keep hitting the ball and you rack up points. Turns out Butch was really good at Pong. Oh my God, I started playing and I couldn't quit. And I just fell in love with video games, asteroids, tech trusts, and so on and so on and so on.

I played all the time. That was my relief. When Bush was killing it at the gaming console, his white classmates stopped pretending he was invisible. I had white people after they talked to me. I had white people to understand I was intelligent. I had white people to know that I like the same things as them. Butch achieved one objective, graduating from Ole Miss. and now he was advancing to the next level.

He moved down to Jackson to attend the University of Mississippi's medical school. Once again, he was one of the first black students to do so, and he thought he was doing really well. But one day, he got called up by the chief of surgery. And he was nervous because surgeons have a reputation in medicine for being kind of high-strung. I thought I was in trouble. The chief of surgery told him,

told Butch that he'd heard he had particularly nimble hands. He said, did you ever think about going into surgery? I paused and I was looking up at the ceiling and finally I got the gumption to utter these words. Well, sir, permission to speak freely. And he said, by all means, please speak freely. I said, don't you have to be an asshole to be a surgeon? The dean told him that the decision to be an asshole, much like the decision to be a surgeon, was a personal one. So, in part because of those nimble hands, Butch started a general surgery residency in Ohio.

And he brought his video games. He introduced his fellow doctors to not just Pong, but newer games, like B-17 bomber. We have tournaments in the residence lounge. I'd be beating everybody, making them cry. You know, because surgeons, surgeons are so competitive. Video game consoles were becoming more portable, small enough to tuck under a hospital TV. Meanwhile, surgery was undergoing its own miniaturization shift. For centuries, surgery meant cutting patients wide open, exposing their organs by making long, deep incisions that left jagged scars and required weeks of recovery.

recovery. But this new procedure called laparoscopy was just starting to catch on. It worked like this. The surgeon made a tiny incision in the patient's body. Through that small opening, they inserted a laparoscope, a thin, rigid tube containing a tiny camera and light source. Next came a couple of other little incisions for the surgical instruments, which were slender tools, nearly a foot long. There were graspers to hold tissue, scissors to cut, and cottery devices to burn blood vessels shut. Because the surgeons couldn't see directly inside the patient's body, they had to peer through the thin tube of the laparoscope. The first time Butch remember seeing this kind of surgery, the patient was a young woman who had pain in her lower right abdomen.

The ER physician thought it was appendicitis. When I did my exam, I thought it was appendicitis. So Butch told the attending surgeon that they should do it. an appendectomy. At the time, a typical appendectomy required an incision of two to four inches and several days in the hospital to recover. He said, wait one moment, young one, wait one he thought they could operate laparoscopically. And when they looked into the lapariscope, they realized it wasn't appendicitis after all. The woman had a twisted ovarian cyst. And he got a needle, put the needle in, suck the cyst out. That girl got up and ran off the table and went home in three hours.

Butch's own mom eventually had laparoscopic surgery. She had her gallbladder removed. Had she undergone this procedure earlier, she might have been spared years of pain. By the late 1980s, laparoscopic surgery had advanced. Instead of peering directly into that tiny laparoscope, surgeons could look at a screen to see inside the patient's body. Butch's career had advanced too.

He finished residency and became one of the things, faces of this new multimedia medical practice. He and a colleague performed the first laparoscopic gallbladder removal at his Ohio hospital. He also operated on the youngest child to undergo a laparoscopic gallbladder removal ever. The patient was less than two years old. Other doctors, and even journalists, regularly dropped in to see Butch work. And it was while talking to a journalist that Butch made a connection he hadn't before. This was around 1990, and he had just completed one of his historic

surgeries. There's just press hanging off the rafters. And after it's a plain dealer reporter asked me, Dr. Rosser, you look so comfortable doing that and this is a new procedure. Why do you think that is?

And that's when it clicked. Like stumbling into a side quest, he hadn't even known existed. I said, because I played video games. and I fly radio control airplanes. Join us as Dr. James C. Rosser and patient Candice Winden take us on a fantastic voyage on the operation.

You can see the connection between Butch the gamer and Butch the surgeon in a 1993 episode of a documentary series from the Learning Channel. In it, Butch calmly narrates what he's doing as he removes the patient's gallbladder. And we're going to open the tummy, make a small hole. Both of his hands are moving swiftly, but he isn't looking down at them. His eyes are fixed on the screen. Now that beautiful red structure looking like mountains in the background, that's the liver.

Instead of the CGI scenery of a video game, he's seeing the landscape of his patient's organs. That is the tip of the gallbladder, that robin's egg blue structure in the middle of your screen. Now let's take a look. He's fluently translating how he manipulates the surgical instruments to what he sees on the monitor. See, we just go and it's just like, in a lot of ways, Nintendo, and just grab and pull. Voila. Eventually, he pulls the gallbladder out through the patient's belly button. All right, we got it.

I tell you, every time I do this surgery and just witness this modern day miracle, you know, and I see people come in with their lives not as disrupted and they're not in the same. as much pain, I'm just so happy. Butch wanted more patients to have access to this kind of surgery. But that required training more surgeons, because most surgeons had never operated looking at a screen.

So that's when I said, I wonder could play in video games helped me in my educational program to get these surgeons up to speed. If it helped me, could it help them? Butch believed video games had made him one of the top laparoscopic

surgeons in the country. And now he was on a mission to get other doctors on his level. More after a break. At Radio Lab, we love nothing more than nerding out about science, neuroscience,

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Productions, the creative studio from WBUR's business partnerships team. Become a thought leader. Recruit new talent. Reach new audiences. Whatever your goal, we can help. Discover how the magic is made at WBUR.org slash creative studio. Butch wanted to get more surgeons performing these minimally invasive surgeries that are less painful for patients. And he wanted to use video games to do it. Now, it had been theorized that it takes 350 hours for anyone to learn how. how to do this. So my goal was to actually see if I could come up with a program that could actually reduce it to eight to 12 hours. He called the program Top Gun after the elite program where Navy

fighter pilots level up their skills. As Bush told that plane dealer journalist, he is also an avid aviation enthusiast. And Top Gun, The Movie, is his all-time. favorite. Is this your idea of fun, man? You can hear how much he loves this movie and this ad he made for the course, with its theatrical music and the sound of planes flying overhead. Hi, I'm Dr. Butch Rosser, the creator of the top gun laparoscopic skills and suturing program. And I have just one question for you. Are you the advanced laparoscopic surgeon that you know you ought to be. Top Gun, the surgical program, focused on drills requiring manual dexterity. Two-hand choreography, 3D depth perception, compensation. All of these are needed attributes of a front-line

21st century surgeon. And here's where the gaming came in, at least at first. Butch remembered those video game battles he'd had with his co-residents. The competition had been fun and motivating. So he assigned points to every Top Gun drill based on speed and accuracy, and he made it a competition with a leaderboard so doctors could see how they stacked up against each other. Once Butch was able to show that the skills he taught in Top Gun translated to skills in real surgical settings, he added actual video games. Fun ones, like Star Wars Racer Revenge and the shoot-em-up video game, Silent Scope. By now, it was the early 2000s.

And video games had a bad rap. And the public imagination, a kid who loved video games, was more likely to be a killer than a surgeon, as exemplified by Joe Lieberbin's remarks at a 1993 congressional hearing. Instead of enriching a child's mind, these games teach a child to enjoy inflicting torture. And Butch says he had other doctors telling him that video games were just frivolous, a way to blow off steam, not to train surgeons.

I was sensitive to that because, you know, I came up where they looked at black people as, you know, not acceptable, not as smart, they can't do this, they can't do that. I came up all my life hearing that. So it didn't phase me. I just kept putting the work in. If Top Gun the Surgery course was Top Gun the movie, Butch was Maverick, doing things. his own way, just like he always had. He partnered with other researchers to evaluate the course with the video games included, and they found that the better doctors were at playing video games, the better they were at the drills, which again simulated actual surgeries.

The video game with the strongest connection to surgical skills? Super Monkey Ball, too. You have to push the little monkey forward, and then you have to not hit the walls. is trying to kill the monkey. And you have to collect so many bananas, which are dodging you. Okay. That is an eventful exercise where your fine motor movement, video spatial compensation, non-dumannhand dexterity, all of that is challenged at once.

So in Super Monkey Ball, you're learning to save the monkey so you can save patients. Yeah, don't kill the monkey. And that's what we hollered. Do not kill the monkey. That's right. Butch and his fellow researchers were excited about this connection. And the idea that maybe if you could get better at a video game like Super Monkey Ball 2, you could become a better surgeon.

You could have doctors being faster with fewer errors if you introduced video games into the curriculum. When Butch and his fellow researchers published their findings in two, the public was also really excited. The idea that playing video games could correlate with something good was breaking news. Dr. Rosser is considered one of the best at this in the world, and it's all because he figured out something no one else had thought of. That was a big breakthrough. You know, it said, oh, Mom, you know, look, I plan DonkeyCom and it still can help me save lives.

Today, there are lots of studies suggesting a link between gaming and minimally invasive surgery. In 2012, researchers in Texas showed that high school sophomores who played video games perform surgery simulations better than surgical residents who didn't. In a Japanese study published earlier this year, showed that medical students with gaming experience had better spatial awareness and more skills associated with laparoscopic surgery. What once was breaking news, now seems almost like common sense. Butch still loves video games, but his goal was never to give them a PR boost. It was always to increase access to potentially life-saving surgeries.

Our biggest challenge now is not the technology. Our biggest challenge now is how to get more people to go into surgery because we have a surgeon shortage. And it's shown that depending on your color, and location, you may or may not be blessed to have these laparoscopic or minimally invasive procedures available to you. And that cannot be allowed to stand. Butch has now run the top gun courses at colleges and even in high schools. The high schoolers play the same games and run the same drills as doctors who take the course. And in some cases,

they perform the drills faster. Butch believes that if these young people make the choice that he did, to pursue surgery as a career, they could potentially start training at an advantage. You can make the whole surgeon training process more efficient because they come in skill-ready. Butch has even done work with students not much older than he was when he set his sights on a medical career. Can learning techniques used to train surgeons help elementary schoolers to?

A central Florida surgeon thinks so. A few years ago, a local news station in Florida where Butch was practicing at the time, covered his efforts to help young people see video game skills and themselves in a new life. I believe people, if they're trained in the right way, if you're approaching the right way, they can do anything. Do you feel like he could be a scientist now?

Yes. Right now, Butch is working on more games for kids. He wants them to be able to picture themselves in the OR and for the journey there to be enjoyable. With all these kids playing for fun, we're going to have some surgeons shake out. He still has lots of ideas about games and medical education that he wants to test. Board games, mobile games, Butch wants to know how else he can invert our expectations about how to save lives. Because I'm going to shake it up sugar as we say it ourselves.

And I'll be doing that until the day I'm not here anymore. That was Grace Tatter, coming right up in our series, Hidden Levels, Another step along our larger quest. Endless threads, Dean Russell, helps us touch grass digitally. Coming out, like right now, in our feed and the feed of 99% invisible. Listening is its own video game. Try and keep up. This episode was written and produced by Grace Tatter.

It was edited by Meg Kramer, Mix and Sound Design by Emily Jankowski. Shout out to Hidden Levels managing producer Chris Barube for his input on this episode. The rest of our team at Endless Thread is Frannie Monaghan, Dean Russell, Amory Siebertsin, myself, managing producer Sumit Joshi and production manager Paul Vikis. Who also wrote a bunch of the music for the series. Heck yeah. And our theme music was composed by Swan Royale and Paul Vikis. Hidden Levels is our series co-produced with 99% Invisible about how the video game world has changed the world beyond video games. Jump over to that feed or keep listening here to go to the next level.

Endless Thread is a podcast about the blurred lines between Super Monkey Ball 2 and surgery. Have an online mystery, untold history, another wild story from the internet. Hit us up. You can email us at Endless Thread at WBUR.org.