Improving Performance Under Mirror-Image Conditions During Laparoscopic Surgery Using The Broadview Camera System

Introduction: Under mirror-image conditions, surgeons often become confused and their task performance may deteriorate. This study aimed to quantitatively investigate the difficulty of performing laparoscopic surgery based on a mirror image and to find methods to improve performance under these conditions.Methods: Twelve medical students with no prior endoscopic surgical experience and 10 surgical residents, each with over 50 laparoscopic surgery experiences, participated in this study. Three measures were assessed using the Hiroshima University Endoscopic Surgical Assessment Device: the deviation with integrated time, the approaching time, and the peak velocity. The scope was placed at 0(circle) (coaxial position), 180(circle) (mirror-image condition), and 180(circle) using the Broadview camera system. Each participant performed the Hiroshima University Endoscopic Surgical Assessment Device task 10 times.Results: The deviation with integrated time, the approaching time, and the peak velocity were better for surgical residents than for novices at 0(circle) (P < 0.001, P = 0.001, P = 0.011). The deviation with integrated time, the approaching time, and the peak velocity at 180(circle) were significantly worse than the corresponding values at 0(circle) (P < 0.0001) for both surgical residents and novices. All three types of Hiroshima University Endoscopic Surgical Assessment Device assessment at 180(circle) were significantly better when the Broadview camera system was used than when it was not (P < 0.0001).Conclusion: This study showed quantitatively the difficulty in manipulating laparoscopic instruments in mirror-image conditions. Using the Broadview camera system improved surgeons' performance under mirror-image conditions during laparoscopic surgery.