The influence of experience and camera holding on laparoscopic instrument movements measured with the TrEndo tracking system

Abstract

Background: Eye-hand coordination problems occur during laparoscopy. This study aimed to investigate the difference in instrument movements between the surgeon him-or herself holding the camera and an assistant holding the camera during performance of a laparoscopic task and to check whether experience of the surgeon plays a role in this issue. Methods: The participants were divided into three groups: experts, residents, and novices. Each participant performed positioning tasks using the right (R) and left (L) hands. During these tasks, the camera was manipulated either by the participant (C self ) or by an assistant (C assistant ). Movements of instruments were recorded with the authorsÕ new TrEndo tracking system. The performance was analyzed using five kinematic parameters: time, path length, three-dimensional (3D) motion smoothness, 1D motion smoothness (along the axis), and depth perception. Results: A total of 46 participants contributed. Three tests were performed: test 1-LC self , test 2-LC assistant , and test 3-RC assistant . In all the tests, the experts performed better than the residents and novices in terms of time, path length, and depth perception. The novices performed better in tests 1-LC self and 2-LC assistant than in test 3-RC assistant in terms of path length, 3D motion smoothness, and depth perception. Conclusions: Laparoscopic experience and the cameraholding factor influenced the performance of laparoscopic tasks on the simulator. Time, path length, and depth perception clearly discriminate between different levels of experience in laparoscopy, whereas 3D and 1D motion smoothness play a limited role. Novices experienced more difficulties when an assistant held the camera. Therefore, self-manipulation of the camera seems to improve novicesÕ eye-hand coordination.Key words: Endoscope -Eye-hand coordination: motion analysis -Laparoscopy: training Minimally invasive surgery (MIS, e.g., laparoscopy) currently is widely used for therapeutic purposes. It is well known that laparoscopy has many advantages for the patient such as reduced morbidity, shorter hospitalization, better cosmetic results, and earlier return to normal activity [6]. Laparoscopic surgery, however, requires expertise in psychomotor skills different from those needed to perform open surgical procedures and results in longer learning curves [8]. These skills include a shift from a three-dimensional (3D) operating field to a 2D monitor display, judgment of altered depth perception and spatial relationships, distorted eye-hand coordination, adaptation to the fulcrum effect, manipulation of long surgical instruments while adjusting for amplified tremor, diminished tactile feedback, and fewer degrees of freedom [12]. To guarantee safe performance of laparoscopy, surgeons must be properly trained, and the procedures must be assessed thoroughly [1] (e.g., as in flight simulators for pilots) [13].Most laparoscopic procedures require the use of an operating team that includes not only a surgeon, but also at least one operating...

EVA: Laparoscopic Instrument Tracking Based on Endoscopic Video Analysis for Psychomotor Skills Assessment

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