Evaluation of Laparoscopic Performance: A Study on the Effect of Image Color

Franck Billmann, MD PhD, Erhard Kiffner, MD, Jean-Marie Le Minor, MD PhD. St. Vincentius Klinikum, Südendstrasse 32, D-76137 Karlsruhe (Germany); Université de Strasbourg, Anatomie, 1 place de l’hôpital, 67000 Strasbourg (France)

OBJECTIVE:
Optimal performance during laparoscopic procedures requires that the rotation of the camera, and thus the image, be kept to a minimum to maintain a stable horizon (Conrad et al., 2006). Although, luminosity and brightness of the organs viewed on the screen are important for orientation during teleoperating. They can impair the precision of our orientation ability (Danis, 1998). The impact of color alteration of the laparoscopic image on the surgeons performance during a procedure was not studied yet and information about this factor are scarce. This study evaluates the effect of color alteration of the laparoscopic image on surgical performance.

METHODS:
Surgical residents (group 1) (n = 20) and attending surgeons (group 2) (n = 20) were tested on two laparoscopic skills. The tasks consisted of: 1°) recognizing given anatomical structures on a laparoscopic image, and 2°) recognizing a bleeding on a laparoscopic image (both displayed on laparoscopic screen). These tasks were assessed on four different and consecutive photographs (one with normal colors, and three main color-modified pictures). The participant’s performance was evaluated based on the time required to complete the tasks and number of errors incurred.

RESULTS:
There was an increased deterioration in the performance of realisation of laparoscopic tasks when the color of the laparoscopic image was modified. Participants showed a statistically significant 20-90% increase in time to completion of the tasks, with error rates increasing from 10% to 20% as the color changes.

CONCLUSIONS:
When evaluated independently and as a group, both novice and experienced laparoscopic surgeons showed significant prolongation to completion of laparoscopic tasks with modification of image color.