Ron Bush

Performance and ergonomic characteristics of expert surgeons using a face-mounted display during virtual reality–simulated laparoscopic surgery: an electromyographically based study

BackgroundDisplay positions for laparoscopy in current operating rooms may not be optimal for surgeon comfort or task performance, and face-mounted displays (FMDs) have been forwarded as a potential ergonomic solution. Little is known concerning expert use characteristics of these devices that might help define their role in future surgical care. The authors report the performance and ergonomic characterization of an FMD using virtual reality simulation technology to recreate the surgical environment.MethodsAn FMD was studied in short- and long-duration trials of validated virtual reality–simulated surgical tasks. For the short-duration phase 7, expert surgeons were familiarized with a task on a conventional monitor, then returned on two separate occasions to repeat the task with the FMD while digital photos were taken during task performance and at the end in a standardized fashion. For the long-duration phase 5, expert surgeons performed two separate trials with repetitive groups of validated tasks for a minimum of 30 min while electromyelogram and performance data were measured. Photos of their gaze angle during and at the end of the trial were taken.ResultsAll the participants consistently assumed a gaze angle slightly below horizontal during task performance. Performance scores on the FMD did not differ from those obtained with a conventional display, and remained stable with repetitive task performance. No participant had electromyelogram signals that exceeded the established thresholds for fatigue, but some had values within the threshold range.ConclusionThe natural gaze angle during simulated surgery was consistently a bit below horizontal during rigorous virtual reality–simulated tasks. Performance was not compromised during expert surgeons’ use of an FMD, nor did muscle fatigue characteristics arise under these conditions. The findings suggest that these devices may represent a viable alternative to conventional displays for minimally invasive surgery, but definition of specific roles requires further investigation.

Ramifications of Single-Port Laparoscopic Surgery Measuring Differences in Task Performance Using Simulation

Introduction. Single-port laparoscopic surgery imposes unique psychomotor challenges. We used surgical simulation to define performance differences between surgeons with and without single-port clinical experience and examined whether a short course of training resulted in improved performance. Methods. Study participants were assigned to 3 groups: resident group (RES), experienced laparoscopic surgeons with (SP) and without (LAP) prior single-port laparoscopic experience. Participants performed the Fundamentals of Laparoscopic Surgery precision cutting task on a ProMIS trainer through conventional ports or with articulating instruments via a SILS Port (Covidien, Inc). Two iterations of each method were performed. Then, 6 residents performed 10 successive single-port iterations to assess the effect of practice on task performance. Results. The SP group had faster task times for both laparoscopic (P = .0486) and single-port (P = .0238) methods. The LAP group had longer path lengths for the single-port task than for the laparoscopic task (P = .03). The RES group was slower (P = .0019), with longer path length (P = .0010) but with greater smoothness (P = .0186) on the single-port task than the conventional laparoscopic task. Resident performance task time (P = .005) and smoothness (P = .045) improved with successive iterations. Discussion. Our data show that surgeons with clinical single-port surgery experience perform a simulated single-port surgical task better than inexperienced single-port surgeons. Furthermore, this performance is comparable to that achieved with conventional laparoscopic techniques. Performance of residents declined dramatically when confronted with the challenges of the single-port task but improved with practice. These results suggest a role for lab-based single-port training.