An Ergonomic Analysis of the Fulcrum Effect in the Acquisition of Endoscopic Skills

Gallagher, Anthony G.; McClure, Neil; McGuigan, Jim; Ritchie, Karen; Sheehy, N. P.

doi:10.1055/s-2007-1001366

Cited by 264 publications

(173 citation statements)

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“…While the poor precision and ergonomics of laparoscopy may exacerbate stress, the improved vision and dexterity associated with robotic technology might help surgeons cope better with stress [3,4]. Although robotic techniques have been associated with better training task performance and less workload than laparoscopic techniques [5,6], limited research has examined if robotic techniques are more beneficial during stressful surgical tasks.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this research, little is known about whether robotic technology benefits the surgeon. Indeed, traditional laparoscopy causes unique challenges for the surgeon, with reduced dexterity of elongated tools, limited freedom of movement within the abdomen, and a 2-dimensional field of view generating high physical and mental demands [3,4]. These limitations mean that dealing with operative stress in laparoscopic procedures can be difficult.…”

Section: Stress In Robotic Surgerymentioning

confidence: 99%

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Robotically assisted laparoscopy benefits surgical performance under stress

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Stress In Robotic Surgerymentioning

confidence: 99%

Robotically assisted laparoscopy benefits surgical performance under stress

et al. 2015

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“…The skill set required for endoscopic surgery is different from the skill set required for traditional ''open'' surgery because of the different operating environment. Endoscopic surgery requires three-dimensional orientation in a twodimensional representation of the operating scene, as well as handling of endoscopic instruments [5,8,9]. Although endoscopic skills can be developed in the operating room successfully, it may not be the most appropriate or efficient environment to acquire such skills, given the steep learning curve that surgeons experience [1,7,11,12].…”

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confidence: 99%

Construct validity of the LapSim: Can the LapSim virtual reality simulator distinguish between novices and experts?

et al. 2007

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Background: Virtual reality simulators may be invaluable in training and assessing future endoscopic surgeons. The purpose of this study was to investigate if the results of a training session reflect the actual skill of the trainee who is being assessed and thereby establish construct validity for the LapSim virtual reality simulator (Surgical Science Ltd., Gothenburg, Sweden). Methods: Forty-eight subjects were assigned to one of three groups: 16 novices (0 endoscopic procedures), 16 surgical residents in training (>10 but <100 endoscopic procedures), and 16 experienced endoscopic surgeons (>100 endoscopic procedures). Performance was measured by a relative scoring system that combines single parameters measured by the computer. Results: The higher the level of endoscopic experience of a participant, the higher the score. Experienced surgeons and surgical residents in training showed statistically significant higher scores than novices for both overall score and efficiency, speed, and precision parameters. Conclusions: Our results show that performance of the various tasks on the simulator corresponds to the respective level of endoscopic experience in our research population. This study demonstrates construct validity for the LapSim virtual reality simulator. It thus measures relevant skills and can be integrated in an endoscopic training and assessment program.

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“…This situation frequently arises when the camera is controlled by an assistant who is not familiar with the anatomic structure of the surgical field. Camera rotation creates certain difficulties for the primary surgeon because the expected relationship between the movement of the surgeon's hand and the movement of the instrument is altered [6]. The surgeon has to adjust his or her manual movements to ensure that the tip of the instrument is reaching the correct surgical site, which is oriented differently from the image shown on the monitor.…”

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Reaction times and the decision-making process in endoscopic surgery

2003

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Background: There are times during endoscopic procedures when the displayed surgical field does not align with the actual field due to rotation of the camera. The surgeon's performance may deteriorate under this situation. However, the effects of misalignment on the decision-making processes during endoscopic procedures have not been fully explored. The present study addresses this problem and suggests a technique that may be used to alleviate it. Methods: Two experiments were completed in a mock endoscopic surgical setup where the image of the work plane inside the training box was either projected on a vertical monitor placed at eye level or superimposed over the training box by means of a half-silvered mirror. The work plane consisted of a start plate and four target plates. The experimenter varied the number of choices of target location among one, two, and four target choices. Rotating the camera about its longitudinal axis misaligned the displayed and the actual work plane. There were two experiments that differed in task difficulty. The task in experiment 1 was to touch the target plate, whereas the task in experiment 2 was to reach, grasp, and transport the object from the target to the start plate. Results: Experiment 1 showed that reaction time increased with the number of the choices for a touch task, in accordance with the Hick-Hyman law. Using a graspand-transport task, experiment 2 replicated experiment 1 and extended the results to show that the use of a superimposed image display facilitated the decisionmaking process, leading to shorter reaction times compared to the vertical image display. Discussion: During endoscopic procedures, the surgeon needs to translate indirect perceptions to instrumentmediated actions by ''mapping'' them through sensorimotor integration. The superimposed image alleviates the mental load of spatial transformations by reducing the difficulty of the required sensorimotor mapping. These findings have important implications for the design of high-quality superimposed display technologies.

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An Ergonomic Analysis of the Fulcrum Effect in the Acquisition of Endoscopic Skills

Abstract: The fulcrum effect has a major detrimental influence on acquisition of endoscopic skills. Further work is required to investigate the role of image inversion in clinical endoscopic training.

Cited by 264 publications

References 0 publications

Robotically assisted laparoscopy benefits surgical performance under stress

Robotically assisted laparoscopy benefits surgical performance under stress

Construct validity of the LapSim: Can the LapSim virtual reality simulator distinguish between novices and experts?

Reaction times and the decision-making process in endoscopic surgery

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