title: Comparison of a supplemental wide field of view versus a single field of view with zoom on performance in minimally invasive surgery.
abstract: BACKGROUND
  The limited space and high magnification involved in minimally invasive surgery (MIS) can cause surgeons to lose sight of an instrument while performing tasks such as suturing and knot-tying. A current strategy employed to locate the instrument is zooming out and in with the endoscope, which can be a time-intensive and iterative task. This study investigates the use of a supplemental wide field of view (FOV) via a second endoscope for locating an instrument outside the FOV in a MIS setting.
  
  
  METHODS
  Ten surgically naïve subjects performed a simple aimed movement task with either hand (dominant or nondominant) under two display conditions: (1) conventional single monitor with zoom, and (2) supplemental wide FOV monitor with no zoom. The task emulated the need to locate an instrument outside the surgeon's FOV and return it to a home position.
  
  
  RESULTS
  The supplemental wide FOV produced significantly faster times [F(3,716) = 173.2, p < 0.001)] compared to a single monitor. The task was accomplished most quickly with the dual monitor with the dominant hand, followed by dual monitor with nondominant hand followed by a single monitor with either hand. There were also significantly fewer errors (t = 3.734, df = 9, p = 0.005) with the supplemental wide FOV. None of the subjects were slower with the dual monitor, and all but one had fewer errors. The variance for both task times and errors were also significantly smaller (p < 0.001 and p = 0.008, respectively) with the supplemental wide FOV indicating that subjects performed with increased reliability.
  
  
  CONCLUSIONS
  The supplemental wide FOV gave the subjects the ability to see their instrument at all times providing a more efficient display than zooming out and in. This enabled faster times and fewer errors while allowing the user to perform the task with more consistency.
authors.affiliation: Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI 48202, USA. acao@dmc.org
authors.forename: Alex
authors.initials: A
authors.lastname: Cao
authors.forename: R
authors.initials: R
authors.lastname: Darin Ellis
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Klein
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Auner
authors.forename: Michael D
authors.initials: MD
authors.lastname: Klein
authors.forename: Abhilash K
authors.initials: AK
authors.lastname: Pandya
mesh_terms: D003626:Data Display; D004867:Equipment Design; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011597:Psychomotor Performance; D012371:Robotics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014584:User-Computer Interface; D020535:Video-Assisted Surgery / Q000295:instrumentation*