title: Image converter eliminates mirror imaging during laparoscopy.
abstract: OBJECTIVE
  In laparoscopy, the term "mirror imaging" is used to describe a visual illusion resulting in paradoxical movements when a surgeon is positioned opposite the laparoscope. Mirror imaging is a common problem, creating difficulty in ergonomics and task performance. We introduce the use of a video image converter box (IC box) to overcome mirror imaging. The IC box converts the analog signal to a digital one, performs image rotation or inversion or both, and then reproduces an analog signal for monitor viewing. A laboratory study evaluated whether the IC box could improve performance during laparoscopic tasks.
  
  
  METHODS
  Fourteen laparoscopic surgeons (10 novice and 4 experienced) completed three laparoscopic tasks while positioned opposite the camera and experiencing mirror imaging: (1). suture cutting; (2). multiple transfers of a piece of foam; and (3). multiple transfers of a pinto bean. Participants were timed during each test both with and without the use of the IC box.
  
  
  RESULTS
  All surgeons completed each task faster using the IC box (P < 0.015). On average, use of the IC box allowed subjects to complete assignments in less than one-third the time needed without the IC box. In Task 3, requiring multiple transfers of a small bean, all participants using the IC box completed the task. However, without the box, only 1 of 14 participants accomplished the goal in the allotted time.
  
  
  CONCLUSIONS
  Use of the IC box eliminates mirror imaging and improves performance and efficiency during laparoscopic tasks. The box would significantly benefit surgeons positioned opposite the camera during laparoscopic surgery.
authors.affiliation: Department of Urology, University of California-Davis, Sacramento, California 95817, USA.
authors.forename: William K
authors.initials: WK
authors.lastname: Johnston
authors.forename: Roger K
authors.initials: RK
authors.lastname: Low
authors.forename: Sakti
authors.initials: S
authors.lastname: Das
mesh_terms: D002983:Clinical Competence; D004867:Equipment Design; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation* / Q000379:methods; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D012680:Sensitivity and Specificity; D013525:Surgical Instruments; D013647:Task Performance and Analysis; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D014741:Video Recording / Q000295:instrumentation*