Effects of camera arrangement on perceptual-motor performance in minimally invasive surgery

Minimally invasive surgery (MIS) is performed for a growing number of treatments. Whereas open surgery requires large incisions, MIS relies on small incisions through which instruments are inserted and tissues are visualized with a camera. MIS results in benefits for patients compared with open surgery, but degrades the surgeon's perceptual-motor performance. We used a laparoscopic simulator to measure effects of type (top, front, side) and number (1, 3) of camera views on manual manipulation and manual aiming tasks. These experimental manipulations had implications for perceptual and cognitive processing including frame of reference, movement compatibility, compression, task-information specificity, information integration, attentional demands, and information extraction. Camera views generally degraded performance compared with direct viewing, but learning occurred. Generally, a top view resulted in the best performance, followed by front and side views. Benefits of multiple views depended on practice and the direction of grasper movement. Mappings between movement direction and camera view, the consistency of those mappings, and task difficulty affected performance. The benefits and costs for perceptual and cognitive processing that were introduced by a given camera view were not necessarily weighted equally. Costs and benefits must be considered specifically for each task and for each combination of camera view and movement direction. Surgeons may consider using a top view, using side views only when necessary, and using a consistent view when performing repetitive movements.