title: Effect of Mirrored Views on Endoscopic and Arthroscopic Skill Performance.
abstract: BACKGROUND
  Arthroscopic procedures may be technically challenging because of impaired vision, limited space, and the 2-dimensional vision of a 3-dimensional structure. Spatial orientation may get more complicated when the camera is pointing toward the surgeon.
  
  
  OBJECTIVE
  Spatial orientation and arthroscopic performance may be improved by simply mirroring the image on the monitor in different configurations regarding the position and orientation of camera and instrument.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Thirty volunteers from an orthopaedic department were divided into 3 equal groups according to their arthroscopic experience (beginners, intermediates, seniors). All subjects were asked to perform a standardized task in a closed box mimicking an endoscopic space. The same task had to be performed in 4 different configurations regarding camera and instrument position and orientation (pointing toward or away from the subject) with either the original or mirrored image on the monitor. Efficiency (time per stick; TPS), precision (successful completion of the task), and difficulty rating using a visual analog scale (VAS) were analyzed.
  
  
  RESULTS
  Mirroring the image demonstrated no advantage over the original images in any configuration regarding TPS. Successful completion of the task was significantly better when the image was mirrored in the configuration with the camera pointing toward and the instrument away from the surgeon. There was a positive correlation between TPS and subjective VAS difficulty rating (r= 0.762,P= .000) and a negative correlation between the successful completion of the task and VAS (r= -0.515,P= .000).
  
  
  CONCLUSIONS
  Mirroring the image may have a positive effect on arthroscopic performance of surgeons in certain configurations. A significantly improved performance was seen when the arthroscope was pointing toward and the grasping instrument pointing away from the subject. Mirroring the image may facilitate surgery in such clinical situations.
  
  
  CONCLUSIONS
  Mirroring the image may facilitate arthroscopic procedures in certain clinical situations.
authors.affiliation: Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland.; Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Benninger
authors.affiliation: Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Meier
authors.affiliation: Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirth
authors.affiliation: Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland.; Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland.
authors.forename: Peter Philipp
authors.initials: PP
authors.lastname: Koch
authors.affiliation: Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Meyer
keywords: arthroscopic image; arthroscopy; endoscopic performance; image mirroring