title: 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 authors' 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 camera-holding 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 novices' eye-hand coordination.
authors.affiliation: Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands. m.k.chmarra@tudelft.nl
authors.forename: M K
authors.initials: MK
authors.lastname: Chmarra
authors.forename: W
authors.initials: W
authors.lastname: Kolkman
authors.forename: F W
authors.initials: FW
authors.lastname: Jansen
authors.forename: C A
authors.initials: CA
authors.lastname: Grimbergen
authors.forename: J
authors.initials: J
authors.lastname: Dankelman
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002983:Clinical Competence; D003867:Depth Perception; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011597:Psychomotor Performance; D013647:Task Performance and Analysis