title: The impact of training under different visual-spatial conditions on reverse-alignment laparoscopic skills development.
abstract: BACKGROUND
  Circumstances may arise during laparoscopic procedures in which alignment of the laparoscope and the instruments is off by 180°, creating a mirror image of the operative field. It has been shown that task performance is degraded under these reverse-alignment conditions, and that the magnitude of performance impairment is directly related to laparoscopic experience and skill. The aim of this study was to determine if reverse-alignment surgical skills could be developed through training.
  
  
  METHODS
  Twenty-two medical students were randomized to train in either reverse- or forward-alignment conditions on a standardized laparoscopic task in a video trainer (peg transfer). Baseline scores were attained for each group under both orientations. Subjects participated in three 1-h training sessions during an 8-week period. Post-training scores were then obtained under both alignment conditions. Pre and post-training scores were compared for users in each study group under both conditions.
  
  
  RESULTS
  Post-training assessments in the forward orientation demonstrated that subjects in the forward-training group improved significantly compared to pre-testing, while the performance of subjects in the reverse-training group did not improve. Under reverse-alignment conditions, both groups improved on post-test assessment, with dramatic improvements observed for those in the reverse-training group.
  
  
  CONCLUSIONS
  Laparoscopic novices can learn to adapt to a sensorimotor discordance in a simulated training environment. While it is possible that skills developed by training under standard forward-alignment conditions can be utilized in situations of extreme visual-spatial discordance, the intentional development of reverse-alignment skills by training under these conditions may prove beneficial to novice surgeons.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, K4/728 CSC, Madison, WI 53792, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Holznecht
authors.forename: Travis
authors.initials: T
authors.lastname: Schmidt
authors.forename: Jon
authors.initials: J
authors.lastname: Gould
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000592:standards; D009949:Orientation / Q000502:physiology; D011597:Psychomotor Performance; D013028:Space Perception / Q000502:physiology; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods; D014741:Video Recording; D014922:Wisconsin