Samaan Sattarzadeh, Adnan Mohsin, Shawn Tsuda, MD. University of Nevada School of Medicine
INTRODUCTION: Advanced laparoscopic procedures occasionally require operating or assisting with the camera oriented between 90 and 270 degrees in relation to the instruments. Prior studies have shown reversed camera operating to be significantly more cumbersome than operating with a forward camera orientation. No current laparoscopic skills training curricula address training in the reversed camera orientation. The aim of this study is to identify laparoscopic training drills that best improve performance when faced with a reversed camera orientation.
METHODS: Thirty medical students were randomly divided into three study arms. All participants were required to perform a laparoscopic peg transfer in the validated Fundamentals of Laparoscopic Surgery manual skills trainer until able to reproduce a time of 48 seconds consecutively in one direction without any errors (peg drops). The experimental arm only practiced conducting the peg drill with the camera in the 180 degree reversed orientation. The intervention arm practiced tracing standardized geometric shapes with the camera in the reversed orientation. The control arm performed the peg transfer with the camera in the forward direction. Times were measured and recorded at the completion of each designated drill. Participants in each group practiced their designated drill for two, three, six, and nine repetitions before being tested by conducting the peg drill in one direction in the reversed camera orientation. An ANOVA analysis was used to compare means across the three groups and a Tukey’s post-hoc test was used to confirm significance (p< 0.05).
RESULTS: Significant differences in time were observed between the reversed camera peg drill group and the control group across all repetitions. The largest difference was after six repetitions (134.63 ± 43.27 seconds), but were still significant after nine repetitions (96.46 ± 37.449 seconds). Significant time decreases in performing the peg transfer with a reversed camera view were observed between participants practicing the reversed camera peg drill versus the group practicing only instrument orientation drills with the reversed view for all repetitions (p<0.05), but not between the reversed camera partial task group and the control group. Errors (peg drops) were insignificant between all groups across all repetitions.
CONCLUSION: Practicing reversed camera drills conferred improvement in performance of a validated laparoscopic task, with the greatest improvement after six repetitions. A reversed camera partial drill designed to provide directional orientation provided no advantage over practicing the same drill in the forward direction. Warm-up laparoscopic drills designed to duplicate real-world movements with a reversed camera orientation may be warranted to improve performance time compared to simple, in vivo directional orientation prior to the activity, or practicing with a forward camera orientation.
Program Number: S091