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, however, this is not always possible. We have chosen to embrace this unique configuration and define its utility as a training tool. Our objective was to determine whether or not the intentional use of reverse alignment visualization during laparoscopic training would improve performance.
A standard box trainer was configured for reverse alignment visualization by arranging a 10mm zero-degree telescope at 180 degrees opposite the surgeon. Two trocars were placed on the surgeon’s side of the box trainer to perform standardized laparoscopic training tasks. Thirty-four medical students and junior surgical residents were randomized to train with either forward alignment (Group 1) or reverse alignment (Group 2) visualization. Enrollees were tested on both modalities before and after a 4-week structured training program specific to their modality. Students’ t-test was used to determine differences in task performance between the two groups.
Twenty-one participants completed the study. There were no significant differences in performance between Group 1 or Group 2 participants during forward or reverse alignment initial testing. At final testing, Group 1 participants had improved only in forward alignment performance: they demonstrated no significant improvement in reverse alignment performance (p=0.343). Group 2 participants had significant improvement in both forward (p=0.019) and reverse alignment performance (p=0.000).
Reverse alignment imaging for laparoscopic training modules 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 dry lab training can account for drastic adaptation to this environment, and should be incorporated into resident training curricula.
Program Number: P159