Endoscopic camera rotation: a conceptual solution to improve hand-eye coordination in minimally-invasive surgery

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Abstract
During minimally-invasive surgery the surgeon's hand-eye coordination is disturbed due to indirect sight of the operative field. Two negative effects occur: the location and the orientation of the operative field presented on the monitor do not correspond to the location and orientation of the actual operative field. This study investigated whether endoscopic task performance improves under the following conditions: with location of the monitor screen at surgeon's hand level; and with rotation of the endoscopic camera so that the instrument movements in the monitor image are no longer misoriented with respect to the actual instrument movements. An endoscopic manipulation task was performed under standardised conditions, except for two varying monitor and camera rotations. The endoscope was positioned so that a 90° misorientation between the displayed instrument and actual instrument existed in the standard condition. Task performance was best when the endoscopic camera was rotated, so that misorientations between the movements of the displayed instrument and the actual instrument were eliminated. The execution time was shorter (p <0.05) and the experienced mental effort was lower (p < 0.01). Monitor location did not significantly influence overall task performance. Rotation of the endoscopic camera, so that misorientations are eliminated, improves eye-hand coordination during endoscopic manipulation.

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