Eye-hand coordination in laparoscopy - an overview of experiments and supporting aids

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Abstract
The indirect method of observing and manipulating impairs the eye-hand coordination of a laparoscopic surgeon. Eye-hand coordination is impaired by two effects: a mislocation of the camera picture and a misorientation of the instrument movements. The mislocation is due to the fact that the surgeon is looking forward to a monitor and not down on his/her hands. The misorientation is caused by a difference between the endoscope's line-of-sight and the surgeon's natural line-of-sight when looking directly into the abdomen. As a result, the instruments on the monitor move in a different direction from that expected. The effects are very confusing, and require a long and intensive training period to overcome. This paper gives an overview of experiments and supporting aids to reduce the effects of mislocation and misorientation. Storz' ViewSite is currently the most simple solution; it relocates the screen above the surgeon's hands. At the Delft University of Technology, research is being carried out on compensation for misorientations. Outcomes of the research are a camera rotation method and a new type of steerable endoscope, the Endo-Periscope.