The impact of training under different visual-spatial conditions on reverse-alignment laparoscopic skills development

Circumstances may arise during laparoscopic procedures in which alignment of the laparoscope and the instruments is off by 180°, creating a mirror image of the operative field. It has been shown that task performance is degraded under these reverse-alignment conditions, and that the magnitude of performance impairment is directly related to laparoscopic experience and skill. The aim of this study was to determine if reverse-alignment surgical skills could be developed through training.

Twenty-two medical students were randomized to train in either reverse- or forward-alignment conditions on a standardized laparoscopic task in a video trainer (peg transfer). Baseline scores were attained for each group under both orientations. Subjects participated in three 1-h training sessions during an 8-week period. Post-training scores were then obtained under both alignment conditions. Pre and post-training scores were compared for users in each study group under both conditions.

Post-training assessments in the forward orientation demonstrated that subjects in the forward-training group improved significantly compared to pre-testing, while the performance of subjects in the reverse-training group did not improve. Under reverse-alignment conditions, both groups improved on post-test assessment, with dramatic improvements observed for those in the reverse-training group.

Laparoscopic novices can learn to adapt to a sensorimotor discordance in a simulated training environment. While it is possible that skills developed by training under standard forward-alignment conditions can be utilized in situations of extreme visual-spatial discordance, the intentional development of reverse-alignment skills by training under these conditions may prove beneficial to novice surgeons.