Interactive Instrument-Driven Image Display in Laparoscopic Surgery.
BACKGROUND
A significant limitation of minimally invasive surgery is dependence of the entire surgical team on a single endoscopic viewpoint. An individualized, instrument-driven image display system that allows all operators to simultaneously define their viewing frame of the surgical field may be the solution. We tested the efficacy of such a system using a modified Fundamentals of Laparoscopic Surgery™ (Society of American Gastrointestinal and Endoscopic Surgeons, Los Angeles, CA) bead transfer task.


METHODS
A program was custom-written to allow zooming and centering of the image window on specific color signals, each attached near the tip of a different laparoscopic instrument. Two controls were used for the bead transfer task: (1) a static, wide-angle view and (2) a single moving camera allowing close-up and tracking of the bead as it was transferred. Time to task completion and number of bead drops were recorded.


RESULTS
Thirty-six sessions were performed by surgical residents. Average time for bead transfer was 127.3±21.3 seconds in the Experimental group, 139.1±27.8 seconds in the Control 1 group, and 186.2±18.5 seconds in the Control 2 group (P=.034, by analysis of variance). Paired analysis (the Wilcoxon Signed-Rank Test) showed that the Experimental group was significantly faster than the Control 1 group (P=.035) and the Control 2 group (P=.028).


CONCLUSIONS
We have developed an image navigation system that allows intuitive and efficient laparoscopic performance compared with two controls. It offers high-resolution images and ability for multitasking. The tracking system centers close-up images on the laparoscopic target. Further development of robust prototypes will help transition this in vitro system into clinical application.
Departments of Surgery and Medical Imaging, Alpert Medical School of Brown University and Rhode Island Hospital , Providence, Rhode Island.
Eleanor A
EA
Fallon
Departments of Surgery and Medical Imaging, Alpert Medical School of Brown University and Rhode Island Hospital , Providence, Rhode Island.
Austin Y
AY
Ha
Departments of Surgery and Medical Imaging, Alpert Medical School of Brown University and Rhode Island Hospital , Providence, Rhode Island.
Derek L
DL
Merck
Departments of Surgery and Medical Imaging, Alpert Medical School of Brown University and Rhode Island Hospital , Providence, Rhode Island.
Sean S
SS
Ciullo
Departments of Surgery and Medical Imaging, Alpert Medical School of Brown University and Rhode Island Hospital , Providence, Rhode Island.
Francois I
FI
Luks
D002983:Clinical Competence; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007396:Internship and Residency; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D020535:Video-Assisted Surgery / Q000295:instrumentation*