A training tool to assess laparoscopic image navigation task performance in novice camera assistants

A number of tools for assessing task performance of the laparoscopic camera assistant have been described, but few focus on the acquisition and assessment of the attainment of proficiency in novice laparoscopic camera assistants. Our aim was to develop a simulated objective assessment tool for a novice camera assistant.

A 10-cycle image navigation task tool was developed. This involved a series of 360° clockwise and anticlockwise rotation maneuvers of a 30° laparoscope along its shaft, focusing on a predefined geometric target on a 45° fixed slope in a laparoscopic box trainer. The tasks were to simultaneously maintain neutral horizon, optimum distance, and centering. Task accuracy and time to completion were assessed objectively at 3-s intervals on an unedited video recording.

Twenty-nine novice medical students were assessed. Novices improved mean total error and task completion time (first versus fifth cycle, mean errors 15.4 versus 8.4, P = 0.048; mean task time 158.1 versus 92.9 s, P = 0.04). This improvement continued until the task cycle was completed (sixth versus 10th cycles, 7.9 versus 6.2, P = 0.01; 91.9 versus 76.6 s, P < 0.0001). There was a significant decrease in centering errors (5.2 versus 2.4, P = 0.001) and horizon (4.8 versus 2.3, P = 0.004), when comparing the first versus fifth task cycle. It took six cycles for optimum distance to achieve significance (5.4 versus 3.3, P = 0.023).

Using our assessment tool, novices achieved an objective proficiency-gain curve for laparoscopic camera navigation tasks. There was improvement in errors related to maintaining horizon, optimum distance, and centering. Mean task completion time also decreased. This tool could be used as an additional mean of assessment and training in novice surgical trainees.