The impact of training under different visual-spatial conditions on reverse-alignment laparoscopic skills development

• Published in: Surgical endoscopy Vol. 26; no. 1; pp. 120 - 123
• Main Authors: Holznecht, Catherine, Schmidt, Travis, Gould, Jon
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.01.2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Biological and medical sciences; Cameras; Clinical Competence - standards; Computer Simulation; Curricula; Digestive system. Abdomen; Education, Medical, Undergraduate - methods; Endoscopy; Gastroenterology; General aspects; Gynecology; Hepatology; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - education; Laparoscopy - standards; Medical sciences; Medical students; Medicine; Medicine & Public Health; Orientation - physiology; Proctology; Psychomotor Performance; Public health; Skill development; Skills; Space Perception - physiology; Surgeons; Surgery; Task Performance and Analysis; Teaching - methods; Training; Wisconsin; Wisconsin; United States > US; Training; Education; Laparoscopic skills; Medicine; Endoscopic surgery; Treatment; Laparoscopy; Endoscopy
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-011-1836-5

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.