title: A randomized comparison of laparoscopic, magnetically anchored, and flexible endoscopic cameras in performance and workload between laparoscopic and single-incision surgery.
abstract: BACKGROUND
  This study aimed to evaluate the surgeon performance and workload of a next-generation magnetically anchored camera compared with laparoscopic and flexible endoscopic imaging systems for laparoscopic and single-site laparoscopy (SSL) settings.
  
  
  METHODS
  The cameras included a 5-mm 30° laparoscope (LAP), a magnetically anchored (MAGS) camera, and a flexible endoscope (ENDO). The three camera systems were evaluated using standardized optical characteristic tests. Each system was used in random order for visualization during performance of a standardized suturing task by four surgeons. Each participant performed three to five consecutive repetitions as a surgeon and also served as a camera driver for other surgeons. Ex vivo testing was conducted in a laparoscopic multiport and SSL layout using a box trainer. In vivo testing was performed only in the multiport configuration and used a previously validated live porcine Nissen model.
  
  
  RESULTS
  Optical testing showed superior resolution for MAGS at 5 and 10 cm compared with LAP or ENDO. The field of view ranged from 39 to 99°. The depth of focus was almost three times greater for MAGS (6-270 mm) than for LAP (2-88 mm) or ENDO (1-93 mm). Both ex vivo and in vivo multiport combined surgeon performance was significantly better for LAP than for ENDO, but no significant differences were detected for MAGS. For multiport testing, workload ratings were significantly less ex vivo for LAP and MAGS than for ENDO and less in vivo for LAP than for MAGS or ENDO. For ex vivo SSL, no significant performance differences were detected, but camera drivers rated the workload significantly less for MAGS than for LAP or ENDO.
  
  
  CONCLUSIONS
  The data suggest that the improved imaging element of the next-generation MAGS camera has optical and performance characteristics that meet or exceed those of the LAP or ENDO systems and that the MAGS camera may be especially useful for SSL. Further refinements of the MAGS camera are encouraged.
authors: Department of Surgery, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9156, USA.
authors: Nabeel A
authors: NA
authors: Arain
authors: Jeffrey A
authors: JA
authors: Cadeddu
authors: Sara L
authors: SL
authors: Best
authors: Thomas
authors: T
authors: Roshek
authors: Victoria
authors: V
authors: Chang
authors: Deborah C
authors: DC
authors: Hogg
authors: Richard
authors: R
authors: Bergs
authors: Raul
authors: R
authors: Fernandez
authors: Erin M
authors: EM
authors: Webb
authors: Daniel J
authors: DJ
authors: Scott
mesh_terms: D000818:Animals; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate; D004724:Endoscopy / Q000193:education / Q000295:instrumentation* / Q000592:standards; D004867:Equipment Design; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000193:education / Q000295:instrumentation / Q000592:standards; D008953:Models, Anatomic; D013525:Surgical Instruments; D034421:Sus scrofa; D013536:Suture Techniques / Q000193:education / Q000592:standards*; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000592:standards*; D016526:Workload