title: An ergonomic analysis of the effects of camera rotation on laparoscopic performance.
abstract: BACKGROUND
  Minimal access surgery is associated with increased risk of complications, particularly early in a surgeon's laparoscopic career. This is mostly due to loss of depth cues, degraded tactile feedback from surgical instrument, and the "fulcrum effect". Degraded and restricted image on the monitor makes camera orientation very important. The objective of this study is to investigate the effects of camera rotation on laparoscopic performance.
  
  
  METHODS
  In two separate studies 100 laparoscopic novices and 7 experienced laparoscopic surgeons ([300 laparoscopic procedures) were asked to perform a simple laparoscopic cutting task and tie intracorporeal square-knots (respectively) under 0, 15, 45, 90, and 180 camera rotation.
  
  
  RESULTS
  In study 1 camera rotation significantly degraded performance of laparoscopic novices (p\0.00001) and also increased their error rate (p\0.00001). In study 2 camera rotation significantly increased the length of time it took surgeons to tie an intracorporeal square-knot (p\0.00001) and the number of errors made (p\0.0001).
  
  
  CONCLUSIONS
  Unintentional camera rotation during surgery should be avoided to eliminate one potential source for errors.
authors.affiliation: National Surgical Training Centre, Royal College of Surgeons in Ireland, 123, St. Stephens Green, Dublin 2, Ireland.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Gallagher
authors.forename: Musallam
authors.initials: M
authors.lastname: Al-Akash
authors.forename: Neal E
authors.initials: NE
authors.lastname: Seymour
authors.forename: Richard M
authors.initials: RM
authors.lastname: Satava
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002983:Clinical Competence / Q000592:standards*; D006804:Ergonomics; D005260:Female; D013502:General Surgery / Q000295:instrumentation / Q000592:standards*; D006801:Humans; D020706:Laparoscopes / Q000592:standards; D010535:Laparoscopy / Q000295:instrumentation / Q000592:standards*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D012399:Rotation; D013536:Suture Techniques / Q000592:standards