Maintaining forward view of the surgical site for best endoscopic practice

Endoscopic surgery performed through patients' natural orifices (NOTES procedures) often require some degree of retroflexion of the operating system. This can cause a misalignment between the displayed image and the actual work plane, leading to performance difficulties. This study investigated the impact of retroflexion on task performance in a simulated environment. Surgeons were required to perform an aiming and pointing task under two experimental conditions: forward-view vs. retroflexed-view. Results showed that both expert and novice surgeons required significantly longer time for completing the task when the scope was retroflexed, compared to when the scope faced forwards. Results address the importance of careful selection of the surgical approach to avoid image retroflexion. Further analysis revealed that the novices were more vulnerable than experts to image distortion with the retroflexed view. This addresses the necessity for surgeons to go through extensive endoscopic training to overcome the visual-motor challenges before they can perform NOTES procedures safely and effectively.