Individualized image display improves performance in laparoscopic surgery.
BACKGROUND
Laparoscopic surgery has made great advances over the years, but it is still dependent on a single viewpoint. This single-lens system impedes multitasking and may provide suboptimal views of the operative field. We have previously developed a prototype of interactive laparoscopic image display to enable individualized manipulation of the displayed image by each member of the operating team. The current study examines whether the concept of individualized image display improves performance during laparoscopic surgery.


METHODS
Individualized display of the endoscopic image was implemented in vitro using two cameras, independently manipulated by each operator, in a Fundamental of Laparoscopic Surgery (Society of American Gastrointestinal and Endoscopic Surgeons) endotrainer model. The standardized bead transfer and endoloop tasks were adapted to a two-operator exercise. Each team of two was paired by experience level (novice or expert) and was timed twice: once while using a single camera (control) and once using two cameras (individualized image).


RESULTS
In total, 20 medical students, residents, and attending surgeons were paired in various combinations. Bead transfer times for the individualized image experiment were significantly shorter in the expert group (61.8 ± 14.8% of control, P=.002). Endoloop task performance time was significantly decreased in both novices (80.3 ± 44.4%, P=.04) and experts (69.5 ± 12.9%, P=.001) using the two-camera set-up.


CONCLUSIONS
Many advances in laparoscopic image display have led to an incremental improvement in performance. They have been most beneficial to novices, as experts have learned to overcome the shortcomings of laparoscopy. Using a validated tool of laparoscopic training, we have shown that efficiency is improved with the use of an individualized image display and that this effect is more pronounced in experts. The concept of individual image manipulation and display will be further developed into a hands-free, intuitive system and must be validated in a clinical setting.
Division of Pediatric Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital , Providence, Rhode Island 02905, USA.
Rajan K
RK
Thakkar
Shaun A
SA
Steigman
Jeremy T
JT
Aidlen
François I
FI
Luks
D002983:Clinical Competence; D003626:Data Display; D010535:Laparoscopy / Q000193:education / Q000379:methods* / Q000592:standards*