Sideways camera rotations of 90° and 135° result in poorer performance of laparoscopic tasks for novices

Objective: The aim of this study was to determine the impact of sideways visuomotor rotations between 0° and 180° on novice performance in a laparoscopic simulator. Background: The laparoscopic surgical environment often involves visuomotor rotations because the laparoscope may be placed to the surgeon's side. Basic research by Cunningham indicated that visuomotor rotations between 90° and 135° result in peak performance decrements. Research by Ames and colleagues failed to replicate Cunningham's results in the laparoscopic environment, possibly due to (a) confounds from carryover effects or (b) use of an alternative laparoscopic training task rather than the straight-line pointing task used by Cunningham. Two experiments were conducted to determine if Cunningham's results generalize to the laparoscopic environment when controlling for carryover effects for a threedimensional "straight-line" pointing task (Experiment 1) and a laparoscopic training task (Experiment 2). Method: In Experiments 1 and 2, participants were assigned to one of five visuomotor rotations: 0°, 45°, 90°, 135°, or 180°. Utilizing a laparoscopic simulator, participants performed either a three-dimensional pointing task (Experiment 1) or a peg transfer task (Experiment 2). Results: In both experiments, visuomotor rotations of 90° or 135° resulted in the poorest performance. Conclusion: When controlling for carryover effects, Cunningham's results generalize to novices' performance of a pointing and a peg transfer task in the laparoscopic environment. Applications: The results indicate that 90° and 135° sideways laparoscope placements may result in worse performance for novices in the laparoscopic environment, indicating potentially longer learning curves for these conditions in the laparoscopic as well as other teleoperation environments.