title: Evaluation of laparoscopic performance with alteration in angle of vision.
abstract: OBJECTIVE
  Optimal placement allows intuitive laparoscope positioning between two working trocars (0 degrees angle). However, this configuration may require the assistant to operate in an awkward position. We evaluated the effect of alteration of laparoscope position on surgeon performance and correlated this with surgical experience.
  
  
  METHODS
  Participants were stratified by laparoscopic experience. Group 1 (N = 10) was naïve (no surgical experience), group 2 (N = 7) had moderate laparoscopic experience (1-100 cases), and group 3 (N = 6) was laparoscopically experienced (>100 cases). Participants were timed performing a simple laparoscopic task three times in a trainer with camera angles randomized along the horizontal plane: 0 degrees , 45 degrees , 90 degrees , 135 degrees , and 180 degrees .
  
  
  RESULTS
  All participants showed progressive deterioration in performance as the angle deviated from baseline. The mean time required to complete the tasks was significantly higher for group 1 v groups 2 and 3 at 135 degrees (158 v 77 and 73 seconds) and 180 degrees (153 v 89 and 86 seconds). Performance curves for each group revealed more pronounced deterioration of performance with alteration in the angle of vision in group 1 than in groups 2 and 3 (P < 0.01). There was no difference between groups 2 and 3 (P = 0.19).
  
  
  CONCLUSIONS
  Even modest alteration in laparoscopic perspective results in deterioration of performance for all levels of surgical experience. Experienced laparoscopists adapt more quickly to complexities presented by alteration in camera angles. Novice surgeons should focus on trocar positioning to maintain intuitive surgical perspective and should refrain from working with alterations in camera angles until significant laparoscopic experience has been gained.
authors.affiliation: Division of Urology, Washington University, Saint Louis, Missouri 63110, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Ames
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Frisella
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: Peter
authors.initials: P
authors.lastname: Shulam
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D002983:Clinical Competence; D006804:Ergonomics; D005069:Evaluation Studies as Topic; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000592:standards; D013997:Time Factors; D018666:Ureteroscopy / Q000592:standards; D013520:Urologic Surgical Procedures / Q000295:instrumentation* / Q000592:standards; D014794:Visual Fields