Laparoscopic Task Performance Research Articles

The Impact of Novel Nontechnical Stressors (Visual and Auditory) on Simulated Laparoscopic Task Performance Among Surgeons and Students

Background: Surgical training emphasizes technical competence. Growing evidence indicates that nontechnical skills are also significant in determining performance. Critically, surgeons should be aware how performance is affected by pressure or distraction. We assessed the impact of novel auditory and visual stressors on performance during a simulated laparoscopic task. We hypothesized that the stressors would worsen performance, and that stress-induced diminution in performance would be inversely related to surgical experience. Methods: Twenty participants (10 surgeons and 10 medical students) completed a peg-threading task using a laparoscopic simulator: three times under control conditions, next with a visual distraction overlay (progressive red saturation of the surgical field, timing personalized to the user's index performance), and then with an auditory distraction overlay (operating theater environment noise). Task completion time and instrument tracking metrics (instrument tip distance traveled and instrument smoothness) were measured. Results: Under control conditions, surgeons completed the task significantly faster, with greater economy of movement, and improved instrument smoothness-compared with students. When exposed to distracting stimuli, the groups behaved differently. Surgeons completed the task more slowly, instrument movements became less smooth (significantly so under audio distraction conditions), but total distance traveled by instruments was unchanged. By contrast, student performance was not impaired and, in some ways, improved. Conclusion: The impact of visual and auditory distraction on surgical performance can be modeled in a laparoscopic simulation environment. The effect of distraction varies according to expertise. This environment may be an effective setting within which to learn to mitigate stress-induced diminution in performance.

Camera realignment imposes a cost on laparoscopic performance

There is an unresolved question about whether realigned visual feedback is beneficial or costly to laparoscopic task performance. We provide evidence that camera realignment imposes a reliable cost on performance across both naive controls and experienced surgeons. This finding clarifies an important ongoing discussion in the literature about the effects of camera realignment, which could inform the strategies that laparoscopic surgeons use in the operating room.

Effect of Emotional Response on the Performance of a Simulated Laparoscopic Task.

An emotional state impacts task performance and cognition. However, evidence of the effect of an induced emotional state on laparoscopic performance has not yet been documented. We investigated whether surgical residents in whom a positive emotion had been induced would produce a better laparoscopic task performance than residents in whom a negative emotional state had been induced. This controlled laboratory study recruited a total of 53 junior surgical residents who were divided into 3 groups. Each group was required to watch 1 of 3 ten-minute videos designed to evoke a positive, neutral, or negative emotion before performing a laparoscopic cholecystectomy on a virtual simulation model. Task performances, as evaluated by a global assessment form and psychomotor metrics that included task time, errors, and path lengths, were compared between the 3 groups. Video watching induced different emotions, as measured by a Visual Analog Scale on feelings. The task time was significantly shorter in the positive (13.7 ± 2.5 minutes) than in the neutrally (17.7 ± 3.9 minutes) and the negatively (18.5 ± 3.8 minutes) induced-emotion groups (P < 0.001).Participants in the positive emotion group completed a laparoscopic cholecystectomy with a significantly lower error rate (2 vs. 4 vs. 7, P = 0.036) and shorter right-handed path length (1089.6 ± 250.6 cm vs. 1287.2 ± 355.5 cm vs. 1410.3 ± 304.1 cm, P = 0.010) than the participants in the neutral and negative emotion groups. A positive emotion can enhance a simulated laparoscopic task performance as assessed by task time and path length. The results indicate that we might improve surgical task performance by adjusting the surgeon's emotional state. We plan a future study that will continue to investigate whether positive emotions can facilitate skill learning.

The effect of preferred music on mental workload and laparoscopic surgical performance in a simulated setting (OPTIMISE): a randomized controlled crossover study

BackgroundWorldwide, music is commonly played in the operation room. The effect of music on surgical performance reportedly has varying results, while its effect on mental workload and key surgical stressor domains has only sparingly been investigated. Therefore, the aim is to assess the effect of recorded preferred music versus operating room noise on laparoscopic task performance and mental workload in a simulated setting.MethodsA four-sequence, four-period, two-treatment, randomized controlled crossover study design was used. Medical students, novices to laparoscopy, were eligible for inclusion. Participants were randomly allocated to one of four sequences, which decided the exposure order to music and operation room noise during the four periods. Laparoscopic task performance was assessed through motion analysis with a laparoscopic box simulator. Each period consisted of ten alternating peg transfer tasks. To account for the learning curve, a preparation phase was employed. Mental workload was assessed using the Surgery Task Load Index. This study was registered with the Netherlands Trial Register (NL7961).ResultsFrom October 29, 2019 until March 12, 2020, 107 participants completed the study, with 97 included for analyzation. Laparoscopic task performance increased significantly during the preparation phase. No significant beneficial effect of music versus operating room noise was observed on time to task completion, path length, speed, or motion smoothness. Music significantly decreased mental workload, reflected by a lower score of the total weighted Surgery Task Load Index in all but one of the six workload dimensions.ConclusionMusic significantly reduced mental workload overall and of several previously identified key surgical stressor domains, and its use in the operating room is reportedly viewed favorably. Music did not significantly improve laparoscopic task performance of novice laparoscopists in a simulated setting. Although varying results have been reported previously, it seems that surgical experience and task demand are more determinative.

Using infrared imaging for assessment of muscular activity in the forearm of surgeons in the performance of laparoscopic tasks.

Surgeons working in laparoscopic surgery are subjected to hard working conditions because of the poor ergonomic characteristics of the workplace. The improvement in the working conditions requires the use of reliable techniques for the assessment of muscular activity. In this article infrared imaging is used and compared with electromyography for the evaluation of muscle activity in the performance of laparoscopic surgical tasks. Electromyography has been widely used for the evaluation of the electrical activity produced by the muscles in the performance of surgery. On the contrary, infrared imaging is an innovative technique that has not been sufficiently explored. An experimental evaluation was carried out using a thermography camera and recording the infrared images from volunteers in different tests. Pearson's correlation was obtained between the electromyography and thermographic measurements in two stages: Endurance Stage (best value: ρ = 0.8401 with p < 0.01) and Surgical Task (best value: ρ = 0.8309 with p < 0.01). The article demonstrates that infrared imaging is a valuable technique for the evaluation of muscle activity in laparoscopic surgery, and it can be compared with electromyography. The main advantages of infrared imaging are that it allows remote measurement and provides activity information in the whole area of interest. However, drawbacks such as delayed response of the infrared imaging due to thermal conductivity of the skin should be considered. Electromyography only provides information in the location of the electrodes, but it is a real-time response. For these reasons, the techniques complement each other.

Impact of Escalating Cognitive Workload and Temporal Demands on Surgeons Cognitive Function

Impact of Escalating Cognitive Workload and Temporal Demands on Surgeons Cognitive Function

Effect of simulator orientation during skills training on performance of basic laparoscopic tasks by veterinary students.

OBJECTIVE To determine whether basic laparoscopic skills acquired during training in the horizontal plane would transfer to the vertical plane and vice versa. DESIGN Evaluation study. SAMPLE POPULATION 26 first- and second-year veterinary students with no prior laparoscopic skills training or surgical experience. PROCEDURES Participants were nonrandomly assigned to 2 groups. Group 1 (n = 15) underwent laparoscopic skills training in the horizontal plane, and group 2 (17) underwent laparoscopic skills training in the vertical plane. Following training, participants were tested on their ability to perform 5 laparoscopic tasks, first in the horizontal plane and then the vertical plane (group 1) or first in the vertical plane and then in the horizontal plane (group 2). All training and testing were performed with an augmented-reality laparoscopic simulator. RESULTS 3 participants in each group did not complete the study. For group 1, scores for 3 of the 5 tasks were significantly worse when tested in the vertical plane than when tested in the horizontal plane. For group 2, scores for 2 of the 5 tasks were significantly worse when tested in the horizontal plane than when tested in the vertical plane. For 3 tasks, the difference in scores for the training versus orthogonal plane was significantly lower for group 2 than for group 1. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that basic laparoscopic skills acquired in 1 plane frequently did not transfer to the orthogonal plane. Because veterinary surgeons may be required to treat patients in various positions, development of laparoscopic training models to simulate the vertical plane is recommended.

A Comparative Study of Generic Visual Components of Two-Dimensional Versus Three-Dimensional Laparoscopic Images

AimsThere is a strong evidence to suggest that 3D imaging improves the laparoscopic task performance when compared against 2D. However, to date, no study has explained why that might be. We identified six generic visual components during laparoscopic imaging and aimed to study each component in both 2D and 3D environments for comparison.MethodsTwenty-four consented laparoscopic novices performed specific isolated tasks in a laparoscopic Endo Trainer in 2D and 3D separately. The six endpoints were the accuracy in detecting changes in the laparoscopic images in the following components: distance, area, angle, curvature, volume and spatial coordinates. All the components except the spatial coordinates were assessed by creation, measurement and comparison. Each component was analysed between 2D and 3D groups and within each group at different values. Tests of spatial coordinates were video-recorded and analysed for error number and error types by human reliability analysis technique. Errors types included past-pointing, not reaching the object and touching the wrong object. The results were statistically analysed with independent T test.ResultsThere was no statistically significant difference between 2D and 3D accuracy in the angle, area, distance and curvature. 3D performed more accurately in comparing volumes (p = 0.05). In spatial coordinates, there were a statistically significant higher number of errors in 2D as compared to 3D (p < 0.001). Past-pointing and touching the wrong objects were significantly higher in 2D (p < 0.05).ConclusionBetween all the visual components, detecting change in volume and the spatial coordinates showed significant improvement in 3D environment when compared to 2D.

The correlation between fundamental characteristics and first-time performance in laparoscopic tasks

BackgroundThe ability of characteristics to predict first time performance in laparoscopic tasks is not well described. Videogame experience predicts positive performance in laparoscopic experiences but its mechanism and confounding-association with aptitude remains to be elucidated. This study sought to evaluate for innate predictors of laparoscopic performance in surgically naive individuals with minimal videogame exposure. MethodsParticipants with no prior laparoscopic exposure and minimal videogaming experience were recruited consecutively from preclinical years at a medical university. Participants completed four visuospatial, one psychomotor aptitude test and an electronic survey, followed by four laparoscopic tasks on a validated Virtual Reality simulator (LAP Mentor™). ResultsTwenty eligible individuals participated with a mean age of 20.8 (±3.8) years. Significant intra-aptitude performance correlations were present amongst 75% of the visuospatial tests. These visuospatial aptitudes correlated significantly with multiple laparoscopic task metrics: number of movements of a dominant instrument (rs ≥ −0.46), accuracy rate of clip placement (rs ≥ 0.50) and time taken (rs ≥ −0.47) (p < 0.05). Musical Instrument experience predicted higher average speed of instruments (rs ≥ 0.47) (p < 0.05). Participant's revised competitive index level predicted lower proficiency in laparoscopic metrics including: pathlength, economy and number of movements of dominant instrument (rs ≥ 0.46) (p < 0.05). ConclusionMultiple visuospatial aptitudes and innate competitive level influenced baseline laparoscopic performances across several tasks in surgically naïve individuals.

Comparison between the effect of a self-administered and a trainer-administered surgical checklist on the laparoscopic task performance

Comparison between the effect of a self-administered and a trainer-administered surgical checklist on the laparoscopic task performance

The effect of a simple intraprocedural checklist on the task performance of laparoscopic novices

BackgroundSurgical checklists are used for error reduction. Checklists are infrequently applied during procedures and have been limited to lists of procedural steps as aid memoires. We aimed to study the effect of a self-administered checklist on the laparoscopic task performance of novices during a standardized task. MethodsTwenty novices were randomized into 2 equal groups, those receiving paper feedback (control group) and those receiving paper feedback and the checklist (checklist group). Subjects performed laparoscopic double knots, repeated over 5 separate stages. Human reliability assessment technique was used for error analysis. Results2,341 errors were detected during the 5 stages. During the first stage, the errors were not significantly different between the 2 groups. The checklist group committed significantly fewer errors as compared with the control group during all the later 4 stages (P < .01). ConclusionsThe simple intraprocedural checklist significantly improved the laparoscopic task performance and the learning curve of laparoscopic novices.

Visuospatial Ability as a Predictor of Novice Performance in Ultrasound-guided Regional Anesthesia

Visuospatial ability correlates positively with novice performance of simple laparoscopic tasks. The aims of this study were to identify whether visuospatial ability could predict technical performance of an ultrasound-guided needle task by novice operators and to describe how emotional state, intelligence, and fear of failure impact on this. Sixty medical student volunteers enrolled in this observational study. The authors used an instructional video to standardize training for ultrasound-guided needle advancement in a turkey breast model and assessed volunteers' performance independently by two assessors using composite error score (CES) and global rating scale (GRS). The authors assessed their "visuospatial ability" with mental rotation test (MRT), group embedded figures test, and Alice Heim group ability test. Emotional state was judged with UWIST Mood Adjective Checklist (UMACL), and fear of failure and general cognitive ability were judged with numerical reasoning test. High CES scores (high error rate) were associated with low MRT scores (ρ = -0.54; P < 0.001). Better GRS scores were associated with better MRT scores (ρ = 0.47; P < 0.001). Regarding emotions, GRS scores were low when anxiety levels were high (ρ = -0.35; P = 0.005) and CES scores (errors) were low when individuals reported feeling vigorous and active (ρ = -0.30; P = 0.01). An MRT predicts novice performance of an ultrasound-guided needling task on a turkey model and as a trait measure could be used as a tool to focus training resources on less-able individuals. Anxiety adversely affects performance. Therefore, both may prove useful in directing targeted training in ultrasound-guided regional anesthesia.

Electroencephalographic Monitoring of Brain Wave Activity During Laparoscopic Surgical Simulation to Measure Surgeon Concentration and Stress: Can the Student Become the Master?

To measure gamma and alpha brain wave activity as a measurement of concentration and stress levels during surgical simulator performance of laparoscopic tasks to determine if expert surgeons have different brain activity patterns compared with intermediate and novice surgeons. After obtaining Institutional Review Board approval, 1st and 2nd year medical students, urology residents (PGY2-PGY5), and attending urologists from one institution were recruited. Participants were stratified by level of experience and performed laparoscopic tasks on the EDGE laparoscopic simulator. Subjects were evaluated for concentration and stress levels using the electroencephalography (EEG) data extracted from the MUSE(™) headband. The MUSE software developer kit (SDK) allowed quantification of gamma and alpha waves during each task. An analysis of variance was used to compare concentration and stress levels between groups. A total of 19 participants were recruited for the study and stratified by surgical experience into novice, intermediate, and expert laparoscopy groups: 6 medical students, 9 urology residents, and 4 attending urologists, respectively. Concentration and stress were quantified by calculating the area under the curve of the gamma and alpha EEG wave tracings. Stress was significantly lower in the attending urologists compared with the residents and medical students during the laparoscopic suturing and trended toward significance in the peg transfer task (P = 0.0003, P = 0.069). Concentration was significantly higher in the expert group compared with the less experienced groups during both the peg and suture tasks (P = 0.036, P = 0.0039). EEG brain activity in more experienced surgeons reveals a significant increase in concentration levels with a decrease in stress during simulated laparoscopic tasks compared with novices. This information may correlate with increased proficiency as well as provide objective feedback of progress along the learning curve with the MUSE SDK.

Predictive value of background experiences and visual spatial ability testing on laparoscopic baseline performance among residents entering postgraduate surgical training.

Emerging evidence suggests that despite dedicated practice, not all surgical trainees have the ability to reach technical competency in minimally invasive techniques. While selecting residents that have the ability to reach technical competence is important, evidence to guide the incorporation of technical ability into selection processes is limited. Therefore, the purpose of the present study was to evaluate whether background experiences and 2D-3D visual spatial test results are predictive of baseline laparoscopic skill for the novice surgical trainee. First-year residents were studied. Demographic data and background surgical and non-surgical experiences were obtained using a questionnaire. Visual spatial ability was evaluated using the PicSOr, cube comparison (CC) and card rotation (CR) tests. Technical skill was assessed using the camera navigation (LCN) task and laparoscopic circle cut (LCC) task. Resident performance on these technical tasks was compared and correlated with the questionnaire and visual spatial findings. Previous experience in observing laparoscopic procedures was associated with significantly better LCN performance, and experience in navigating the laparoscopic camera was associated with significantly better LCC task results. Residents who scored higher on the CC test demonstrated a more accurate LCN path length score (r s(PL)=-0.36, p=0.03) and angle path (r s(AP)=-0.426, p=0.01) score when completing the LCN task. No other significant correlations were found between the visual spatial tests (PicSOr, CC or CR) and LCC performance. While identifying selection tests for incoming surgical trainees that predict technical skill performance is appealing, the surrogate markers evaluated correlate with specific metrics of surgical performance related to a single task but do not appear to reliably predict technical performance of different laparoscopic tasks. Predicting the acquisition of technical skills will require the development of a series of evidence-based tests that measure a number of innate abilities as well as their inherent interactions.

Sideways camera rotations of 90° and 135° result in poorer performance of laparoscopic tasks for novices.

The aim of this study was to determine the impact of sideways visuomotor rotations between 0° and 180° on novice performance in a laparoscopic simulator. The laparoscopic surgical environment often involves visuomotor rotations because the laparoscope may be placed to the surgeon's side. Basic research by Cunningham indicated that visuomotor rotations between 90° and 135° result in peak performance decrements. Research by Ames and colleagues failed to replicate Cunningham's results in the laparoscopic environment, possibly due to (a) confounds from carryover effects or (b) use of an alternative laparoscopic training task rather than the straight-line pointing task used by Cunningham. Two experiments were conducted to determine if Cunningham's results generalize to the laparoscopic environment when controlling for carryover effects for a three-dimensional "straight-line" pointing task (Experiment 1) and a laparoscopic training task (Experiment 2). In Experiments 1 and 2, participants were assigned to one of five visuomotor rotations: 0°, 45°, 90°, 135°, or 180°. Utilizing a laparoscopic simulator, participants performed either a three-dimensional pointing task (Experiment 1) or a peg transfer task (Experiment 2). In both experiments, visuomotor rotations of 90° or 135° resulted in the poorest performance. When controlling for carryover effects, Cunningham's results generalize to novices' performance of a pointing and a peg transfer task in the laparoscopic environment. The results indicate that 90° and 135° sideways laparoscope placements may result in worse performance for novices in the laparoscopic environment, indicating potentially longer learning curves for these conditions in the laparoscopic as well as other teleoperation environments.

The effect of divided attention on novices and experts in laparoscopic task performance.

Attention is important for the skilful execution of surgery. The surgeon's attention during surgery is divided between surgery and outside distractions. The effect of this divided attention has not been well studied previously. We aimed to compare the effect of dividing attention of novices and experts on a laparoscopic task performance. Following ethical approval, 25 novices and 9 expert surgeons performed a standardised peg transfer task in a laboratory setup under three randomly assigned conditions: silent as control condition and two standardised auditory distracting tasks requiring response (easy and difficult) as study conditions. Human reliability assessment was used for surgical task analysis. Primary outcome measures were correct auditory responses, task time, number of surgical errors and instrument movements. Secondary outcome measures included error rate, error probability and hand specific differences. Non-parametric statistics were used for data analysis. 21109 movements and 9036 total errors were analysed. Novices had increased mean task completion time (seconds) (171 ± 44SD vs. 149 ± 34, p < 0.05), number of total movements (227 ± 27 vs. 213 ± 26, p < 0.05) and number of errors (127 ± 51 vs. 96 ± 28, p < 0.05) during difficult study conditions compared to control. The correct responses to auditory stimuli were less frequent in experts (68 %) compared to novices (80 %). There was a positive correlation between error rate and error probability in novices (r (2) = 0.533, p < 0.05) but not in experts (r (2) = 0.346, p > 0.05). Divided attention conditions in theatre environment require careful consideration during surgical training as the junior surgeons are less able to focus their attention during these conditions.

Three-dimensional imaging improves surgical skill performance in a laparoscopic test model for both experienced and novice laparoscopic surgeons.

The objective of this study was to evaluate and compare the impact of three-dimensional (3D) imaging system on the performance of basic laparoscopic tasks in a test model by novice and experienced surgeons. Three tasks were performed in a test model by 30 surgeons, 15 experienced surgeons, and 15 with minimal laparoscopic experience. The tasks were performed using 2D and 3D vision systems. Canadian Task Force II-1. Fifteen experienced laparoscopic surgeons and fifteen novices with minimal laparoscopic experience. Performance times were recorded using both two-dimensional and 3D imaging system for each task. Performance time for all skills was significantly (P < 0.02) shorter when using 3D imaging system. Performance times were reduced by 18-31% using 3D imaging for all participants. Experienced surgeons performed the tasks faster and showed similar improvement while using 3D imaging system. 3D vision systems allow for significant improvement in performance times of basic laparoscopic tasks in a test model for both inexperienced and advanced laparoscopic surgeons. Experienced surgeons benefit as much as novices from 3D imaging system. This benefit should be weighed against the disadvantages of the 3D vision systems, mainly cost, decreased light, eye strain, headaches, and shorter focal lengths.

Soft-light Overhead Illumination Systems Improve Laparoscopic Task Performance

The aim of this study was to evaluate the impact of attached shadow cues for laparoscopic task performance. We developed a soft-light overhead illumination system (SOIS) that produced attached shadows on objects. We compared results using the SOIS with those using a conventional illumination system with regard to laparoscopic experience and laparoscope-to-target distances (LTDs). Forty-two medical students and 23 surgeons participated in the study. A peg transfer task (LTD, 120 mm) for students and surgeons, and a suture removal task (LTD, 30 mm) for students were performed. Illumination systems were randomly assigned to each task. Endpoints were: total number of peg transfers; percentage of peg-dropping errors; and total execution time for suture removal. After the task, participants filled out a questionnaire on their preference for a particular illumination system. Total number of peg transfers was greater with the SOIS for both students and surgeons. Percentage of peg-dropping errors for surgeons was lower with the SOIS. Total execution time for suture removal was shorter with the SOIS. Forty-five participants (69% in total) evaluated the SOIS for easier task performance. The present results confirm that the SOIS improves laparoscopic task performance, regardless of previous laparoscopic experience or LTD.

Effect of Visual Display Location on Human Performance in Simulated Laparoscopic Tasks

Laparoscopy is a minimally invasive surgery practiced through small incisions in the body, and requiring the use of long-reach instruments and a camera. Since the video feed is displayed on a monitor, depth perception can be significantly altered, and it is hypothesized that such alterations may depend on the relative position of the monitor with respect to the operator. The objective of this study was to explore the relationship between monitor positioning and human performance in laparoscopic tasks. A total of eight male subjects volunteered to perform a variety of simulated laparoscopic tasks including object transfers, precision cutting, and suturing while three different monitor configurations were used (i.e., left, center, and right of the user). Tool trajectory was monitored using a motion capturing system, and task performance was evaluated using human performance quantitative metrics including completion time, depth of penetration, path length, axial speed, and motion smoothness. Results showed that human performance significantly increased when monitor location was centered with respect to the user during precision cutting. Moreover, subjects’ performance decreased when the monitor was placed on their dominant-hand side. The findings of this study suggest ergonomic guidelines for optimizing human performance in simulated and actual laparoscopic tasks. Specifically, placing the monitor in a central position with respect to the user should represent the standard configuration while conducting laparoscopy.

853 ON SCREEN FRAME OF REFERENCE SYSTEM AND STANDARDIZED COMMUNICATION PROMOTES SAFE AND EFFICIENT LAPAROSCOPIC TEACHING A THREE ARMED RANDOMIZED CONTROL TRIAL

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment/Ureteroscopy I1 Apr 2012853 ON SCREEN FRAME OF REFERENCE SYSTEM AND STANDARDIZED COMMUNICATION PROMOTES SAFE AND EFFICIENT LAPAROSCOPIC TEACHING A THREE ARMED RANDOMIZED CONTROL TRIAL Rami Elias, Kiara Hennessey, Bechir Hage, David Williams, Forough Farrokhyar, and Edward Matsumoto Rami EliasRami Elias Hamilton, Canada More articles by this author , Kiara HennesseyKiara Hennessey Hamilton, Canada More articles by this author , Bechir HageBechir Hage Hamilton, Canada More articles by this author , David WilliamsDavid Williams Hamilton, Canada More articles by this author , Forough FarrokhyarForough Farrokhyar Hamilton, Canada More articles by this author , and Edward MatsumotoEdward Matsumoto Hamilton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.946AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During minimally invasive procedures, the staff surgeon frequently needs to direct the novice trainee to certain points on a surgical field. Variability between verbal instructions may be a source of errors, confusion, and conflicts. To have a successful outcome, errors need to be minimized and communication clear between involved members. We have developed a novel on screen frame of reference (FOR) system, coupled with standardized verbal commands to facilitate intra-operative teaching. The objective of this study was to determine the impact of two novel FOR systems used with a standardized language on performance of laparoscopic tasks when compared to standard techniques. METHODS Sixty-three medical students were randomized to three groups. Group 1 (control) performed tasks with no overlay. The commands were limited to simple directions such as left, right, up and down. Group 2 performed tasks on an overlay with commands based on a clock and x:y triangulation (Fig 1). Group 3 performed tasks on an overlay with an alphanumeric coordinate system. All subjects performed three different trials, each consisting of six object transfers, while instructed with one of the three methods. Time to task completion and error score defined as the number of times the object is moved to a wrong circle were recorded and analyzed using non-parametric statistics. RESULTS Group 2 (69, 70, 56) was significantly faster than the control (86, 80, 71, p<0.05) as well as Group 3 (92, 85, 68, p<0.05) across all three trials. Group 2 (0.94, 0.97, 0.26) had fewer errors than the control (1.43, 1.14, 0.81) across trials 1 and 3 (p<0.05) but similar error scores to Group 3 (0.68, 0.68, 0.23). Although Group 3 had similar time to completion to the control, there were statistically fewer errors (0.68, 0.68, 0.23, p<0.05). CONCLUSIONS Using a frame of referencing overlay and standardized communication for directing laparoscopy promotes safe and efficient endoscopic teaching. This data has given impetus to the development of an on screen, real time video overlay of a frame of referencing system for endoscopic monitors. This system is the first of its kind that has been validated with proven literature and will ultimately help improve teaching and patient safety during endoscopic surgery. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e348 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rami Elias Hamilton, Canada More articles by this author Kiara Hennessey Hamilton, Canada More articles by this author Bechir Hage Hamilton, Canada More articles by this author David Williams Hamilton, Canada More articles by this author Forough Farrokhyar Hamilton, Canada More articles by this author Edward Matsumoto Hamilton, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...