A clearly visible endoscopic instrument shaft on the monitor facilitates hand-eye coordination.

Abstract

Passing an instrument through a small incision alters the kinematics of the instrument, thus hampering hand-eye coordination. Nevertheless, the incision provides a stable, nearly invariant, point of rotation for instrument movements. Therefore, we set out to evaluate the effects of the altered kinematics on hand-eye coordination. In addition, we assessed the hypothesis that the hand-eye coordination of laparoscopic surgeons incorporates the incision as a point of reference. Eight surgeons with experience in laparoscopy repeatedly performed a positioning task on a two-dimensional endoscopic manipulation simulator. Task time was measured. In the first experiment, normal endoscopic manipulation was compared to a condition in which the kinematic effects of the incision were compensated for. In the second experiment, the instrument shaft on the monitor was not visible during half of the trials, so that all visual information about the location of the incision was obscured. Task performance improved significantly when the kinematic effects of the incision were compensated for (p = 0.001). Task performance improved when the instrument shaft was clearly visible on the monitor (p <0.05). Compensating for the kinematic effects introduced by the incision improves hand-eye coordination. The results of this study indicate that the incision provides a point of reference for hand-eye coordination during endoscopic manipulation.