Effect of automatic image realignment on visuomotor coordination in simulated laparoscopic surgery

During laparoscopic surgery, the surgeon's hand-eye coordination is often disrupted by the incongruent mapping between the orientation of the endoscopic view and the actual operative field. Two experiments were conducted to examine the effect of automatic image realignment on the performance of laparoscopic surgery. The first experiment investigated how visual-motor misalignment impacted laparoscopic surgery performance. Novice subjects were randomly assigned to one of the two paired viewing conditions in a simulated laparoscopic surgery environment: 1) the endoscope was either at the center of the modeled workspace with an optical axis of 90°, or at -45° from the midline of the subjects with an optical axis 45°; 2) the endoscope was either at 0°, or at 180° from the midline of the subjects, both with an optical axis of 45°. Each group of twelve subjects performed a dynamic point-and-touch task under the assigned pair of viewing conditions, each with eight image orientations, in a repeated-measures mixed design. The second experiment examined whether the automatic realigning mechanism that was activated mid-task (such that a congruent mapping between display and control was re-established if the mapping at the beginning of the task had been misaligned) was helpful to improve performance. Twelve novice subjects performed the same task as in the first experiment in a repeated-measures design. Performance was examined under three misaligned visuomotor mappings, each followed by the realigned mapping activated by the automatic realigning mechanism. Results showed that performance was best when the endoscopic image was perfectly aligned with the actual task space (0° image orientation), but degraded progressively as a function of deviation from perfect alignment. Subjects' performance maintained a consistent pattern across 8 image orientations regardless of optical axis orientation and endoscope location. Performance was improved with the automatic realigning mechanism. It is recommended that any solution to restore the visuomotor congruency in laparoscopic surgery should first align the image with the task space. This work has implications for the design of visualization systems in laparoscopic surgery.