Reverse Alignment “Mirror Image” Visualization as a Laparoscopic Training Tool Improves Task Performance

Abstract

Reverse alignment (mirror image) visualization is a disconcerting situation occasionally faced during laparoscopic operations. This occurs when the camera faces back at the surgeon in the opposite direction from which the surgeon's body and instruments are facing. Most surgeons will attempt to optimize trocar and camera placement to avoid this situation. The authors' objective was to determine whether the intentional use of reverse alignment visualization during laparoscopic training would improve performance. A standard box trainer was configured for reverse alignment, and 34 medical students and junior surgical residents were randomized to train with either forward alignment (DIRECT) or reverse alignment (MIRROR) visualization. Enrollees were tested on both modalities before and after a 4-week structured training program specific to their modality. Student's t test was used to determine differences in task performance between the 2 groups. Twenty-one participants completed the study (10 DIRECT, 11 MIRROR). There were no significant differences in performance time between DIRECT or MIRROR participants during forward or reverse alignment initial testing. At final testing, DIRECT participants had improved times only in forward alignment performance; they demonstrated no significant improvement in reverse alignment performance. MIRROR participants had significant time improvement in both forward and reverse alignment performance at final testing. Reverse alignment imaging for laparoscopic training improves task performance for both reverse alignment and forward alignment tasks. This may be translated into improved performance in the operating room when faced with reverse alignment situations. Minimal lab training can account for drastic adaptation to this environment.

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

“…This may simply reflect improvement in motor skills and increased familiarity with the equipment. Dunnican et al [12] conducted a similar study to ours and determined that training in reverse-alignment conditions resulted in the development of both forward-and reversealignment skills; however, forward-alignment training improved only forward-alignment performance. The reasons for this minor discrepancy between our studies are not clear, but we believe the central theme in each is that through training, surgeons can learn to adapt to reversealignment conditions.…”

“…It has been demonstrated that training can improve an individual's ability to perform these mental rotations [10]. Researchers have found that the skills learned through training in mental rotation tasks are transferrable to tasks that are structurally different yet rely on similar mental processing [11,12]. Stransky et al [12] has shown that the skills learned through mental rotation training are also transferrable to certain FLS tasks performed in a video trainer.…”

“…Researchers have found that the skills learned through training in mental rotation tasks are transferrable to tasks that are structurally different yet rely on similar mental processing [11,12]. Stransky et al [12] has shown that the skills learned through mental rotation training are also transferrable to certain FLS tasks performed in a video trainer. Performance on the FLS precision-cutting task improved with mental rotation training.…”

A randomized comparison of laparoscopic, magnetically anchored, and flexible endoscopic cameras in performance and workload between laparoscopic and single-incision surgery

“…In fact, the MAGS camera had to be held off center so an appropriate view of the operative field could be obtained. It is well known that holding a camera off axis increases the psychomotor demands of a given task in a traditional multiport setting and results in a degraded task performance [25,[33][34][35][36][37]. For ex vivo testing, the experts seemed to compensate completely for this increased level of difficulty, whereas the fellows did not (Fig.…”

Training in minimally invasive surgery in urology: European Association of Urology/International Consultation of Urological Diseases consultation

“…The comparison of other methods such as VR trainers with the BTs showed that differences were present in some of the measured outcomes. Nevertheless, these results were based on small randomized controlled trials and no specific conclusions could be drawn in the case of novice trainees .…”