INTRODUCTION: Laparoscopic surgery presents several challenges to the novice learner. Laparoscope positioning has been suggested to affect performance. We hypothesized that an off-center laparoscope position would lead to poorer performance and increased workload of the performer.
METHODS: General surgery residents (n=11) voluntarily participated in the study protocol. In a live porcine model, three trocars were placed: one in the midline 10 cm inferior to the xiphoid, and one 10 cm laterally from the first trocar on both sides. Participants were asked to complete an intracorporeal suture and knot tying task on pre-placed targets located 2 cm apart on the anterior surface of the stomach under two conditions: (a) with the laparoscope located in the midline port and (b) with the laparoscope located in the left port, at a 45 degree angle. The order of task performance (centered versus angled laparoscope position) was random. An objective performance score was computed based on time required and the security, accuracy, and gap of the created knot. Participants also rated their subjective workload with each task using the validated NASA-TLX workload assessment questionnaire. Participant performance and workload data were compared between the two laparoscope positions using a paired t test. Data are reported as mean ± s.d. A p-value < 0.05 was considered significant.
RESULTS: Eleven residents (PGY 1-6) with a mean age of 31 and mean case experience of 183 laparoscopic procedures participated. Subjects had significantly poorer performance with the laparoscope in the 45 degree angled position compared with the center position (score 255±138 vs. 385±124, respectively; p = 0.036). Working with the laparoscope in a side port created a significantly higher workload compared with a centered laparoscope (score 74.4±13.1 vs. 57.5±18.9, respectively; p = 0.012).
CONCLUSIONS: Laparoscope positioning has a significant impact on resident surgeon performance and workload. This finding emphasizes the need to optimize the laparoscope position intraoperatively. In addition, it highlights the importance of incorporating altered laparoscope positioning in simulation exercises early in training to better prepare surgeons for the dynamic operative environment of laparoscopy.
Program Number: P211