Novel hands-free pointer improves instruction efficiency in laparoscopic surgery

To improve instruction efficiency during advanced laparoscopic surgery, a hands-free, head-controlled, multimonitor pointer was developed. One instructor guided 20 trainees to locate critical points on a simulated laparoscopic cholecystectomy model. Twenty points, visible to the instructor only, were selected on a photo of a partially dissected gallbladder placed within a laparoscopic trainer box. For each trainee, the points were randomized to 2 groups of 10 points with the instructor providing verbal guidance only or guidance assisted by the head-controlled pointer that appeared on both the instructor's and trainees' monitors. The primary outcome was the time to locate 10 points. Total time was shorter with the pointer than with verbal guidance alone (65 +/- 14 vs 119 +/- 34 seconds, P < .001). The average of mean individual times to locate each point was shorter with the pointer than without (5.4 +/- 0.5 vs 11.9 +/- 2.4 seconds, P < .001). The instructor's efficiency improved over time with both verbal guidance (P = .007) and with the pointer (P = .001). The benefit of pointer instruction was greater in trainees with laparoscopic experience compared with those without experience (P = .006). Use of a hands-free pointer improved instruction efficiency in simulated laparoscopy. Experienced surgeons benefited the most.