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Perceptual impairment and psychomotor control in virtual laparoscopic surgery.

Wilson MR, McGrath JS, Vine SJ, Brewer J, Defriend D, Masters RS - Surg Endosc (2011)

Bottom Line: Performance, movement, gaze, and eye-hand coordination parameters were recorded and compared between groups.The experienced surgeons completed the task significantly more quickly than the novices, used significantly fewer movements, and displayed shorter tool paths.Gaze analyses revealed that experienced surgeons spent significantly more time fixating the target locations than novices, who split their time between focusing on the targets and tracking the tools.

View Article: PubMed Central - PubMed

Affiliation: School of Sport and Health Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK. Mark.Wilson@exeter.ac.uk

ABSTRACT

Background: It is recognised that one of the major difficulties in performing laparoscopic surgery is the translation of two-dimensional video image information to a three-dimensional working area. However, research has tended to ignore the gaze and eye-hand coordination strategies employed by laparoscopic surgeons as they attempt to overcome these perceptual constraints. This study sought to examine if measures related to tool movements, gaze strategy, and eye-hand coordination (the quiet eye) differentiate between experienced and novice operators performing a two-handed manoeuvres task on a virtual reality laparoscopic surgical simulator (LAP Mentor™).

Methods: Twenty-five right-handed surgeons were categorised as being either experienced (having led more than 60 laparoscopic procedures) or novice (having performed fewer than 10 procedures) operators. The 10 experienced and 15 novice surgeons completed the "two-hand manoeuvres" task from the LAP Mentor basic skills learning environment while wearing a gaze registration system. Performance, movement, gaze, and eye-hand coordination parameters were recorded and compared between groups.

Results: The experienced surgeons completed the task significantly more quickly than the novices, used significantly fewer movements, and displayed shorter tool paths. Gaze analyses revealed that experienced surgeons spent significantly more time fixating the target locations than novices, who split their time between focusing on the targets and tracking the tools. A more detailed analysis of a difficult subcomponent of the task revealed that experienced operators used a significantly longer aiming fixation (the quiet eye period) to guide precision grasping movements and hence needed fewer grasp attempts.

Conclusion: The findings of the study provide further support for the utility of examining strategic gaze behaviour and eye-hand coordination measures to help further our understanding of how experienced surgeons attempt to overcome the perceptual difficulties inherent in the laparoscopic environment.

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Images of the LAP Mentor™ environment showing representative examples of the “two-handed manoeuvres” task: grasping and manipulating the jelly to reveal a ball (A), grasping a ball (B), and dropping a ball in the endobag (C)
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Fig1: Images of the LAP Mentor™ environment showing representative examples of the “two-handed manoeuvres” task: grasping and manipulating the jelly to reveal a ball (A), grasping a ball (B), and dropping a ball in the endobag (C)

Mentions: Testing took place on a LAP Mentor™ (Simbionix USA Corp., Cleveland, OH) VR laparoscopic surgical simulator, based at the Centre for Innovation and Training in Elective Care, Torbay Hospital. The two-handed manoeuvres task from the basic skills training module was used for this study as recent research has suggested that it discriminates between levels of expertise across a range of objective performance and S–T measures [2]. To complete the task the operator must locate balls within a jelly mass and then place them in an endobag. There are three subcomponents to this task requiring accurate psychomotor control: (1) grasping the jelly and manipulating it to expose a ball, (2) grasping a ball, and (3) placing the ball in the endobag (Fig. 1).Fig. 1


Perceptual impairment and psychomotor control in virtual laparoscopic surgery.

Wilson MR, McGrath JS, Vine SJ, Brewer J, Defriend D, Masters RS - Surg Endosc (2011)

Images of the LAP Mentor™ environment showing representative examples of the “two-handed manoeuvres” task: grasping and manipulating the jelly to reveal a ball (A), grasping a ball (B), and dropping a ball in the endobag (C)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3116127&req=5

Fig1: Images of the LAP Mentor™ environment showing representative examples of the “two-handed manoeuvres” task: grasping and manipulating the jelly to reveal a ball (A), grasping a ball (B), and dropping a ball in the endobag (C)
Mentions: Testing took place on a LAP Mentor™ (Simbionix USA Corp., Cleveland, OH) VR laparoscopic surgical simulator, based at the Centre for Innovation and Training in Elective Care, Torbay Hospital. The two-handed manoeuvres task from the basic skills training module was used for this study as recent research has suggested that it discriminates between levels of expertise across a range of objective performance and S–T measures [2]. To complete the task the operator must locate balls within a jelly mass and then place them in an endobag. There are three subcomponents to this task requiring accurate psychomotor control: (1) grasping the jelly and manipulating it to expose a ball, (2) grasping a ball, and (3) placing the ball in the endobag (Fig. 1).Fig. 1

Bottom Line: Performance, movement, gaze, and eye-hand coordination parameters were recorded and compared between groups.The experienced surgeons completed the task significantly more quickly than the novices, used significantly fewer movements, and displayed shorter tool paths.Gaze analyses revealed that experienced surgeons spent significantly more time fixating the target locations than novices, who split their time between focusing on the targets and tracking the tools.

View Article: PubMed Central - PubMed

Affiliation: School of Sport and Health Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK. Mark.Wilson@exeter.ac.uk

ABSTRACT

Background: It is recognised that one of the major difficulties in performing laparoscopic surgery is the translation of two-dimensional video image information to a three-dimensional working area. However, research has tended to ignore the gaze and eye-hand coordination strategies employed by laparoscopic surgeons as they attempt to overcome these perceptual constraints. This study sought to examine if measures related to tool movements, gaze strategy, and eye-hand coordination (the quiet eye) differentiate between experienced and novice operators performing a two-handed manoeuvres task on a virtual reality laparoscopic surgical simulator (LAP Mentor™).

Methods: Twenty-five right-handed surgeons were categorised as being either experienced (having led more than 60 laparoscopic procedures) or novice (having performed fewer than 10 procedures) operators. The 10 experienced and 15 novice surgeons completed the "two-hand manoeuvres" task from the LAP Mentor basic skills learning environment while wearing a gaze registration system. Performance, movement, gaze, and eye-hand coordination parameters were recorded and compared between groups.

Results: The experienced surgeons completed the task significantly more quickly than the novices, used significantly fewer movements, and displayed shorter tool paths. Gaze analyses revealed that experienced surgeons spent significantly more time fixating the target locations than novices, who split their time between focusing on the targets and tracking the tools. A more detailed analysis of a difficult subcomponent of the task revealed that experienced operators used a significantly longer aiming fixation (the quiet eye period) to guide precision grasping movements and hence needed fewer grasp attempts.

Conclusion: The findings of the study provide further support for the utility of examining strategic gaze behaviour and eye-hand coordination measures to help further our understanding of how experienced surgeons attempt to overcome the perceptual difficulties inherent in the laparoscopic environment.

Show MeSH