Spatial perception in macroscopic and microscopic surgical manipulations: differences between experienced and...

The spatial perceptions of the phantom surgical field with the naked eye and under the surgical microscope were analyzed in a group of experienced and a group of inexperienced neurosurgeons. The phantom surgical field contained a start point, a virtual gate, and a target point. The virtual gate was an invisible zone arbitrarily set in the phantom surgical field. The examinees were first instructed regarding the position of the invisible virtual gate. Then they were asked to point consecutively to the three points with a suction tube under three different circumstances: with the naked eye, under the microscope, and by watching a navigation monitor. A surgical navigator was used to record the three-dimensional position of the suction tip. The pointing deviation from the suction tip to the center of the virtual gate was evaluated. The pointing accuracy with the naked eye did not differ between the two groups, but that under the microscope was significantly better in the experienced group than in the inexperienced group. Fluctuations in pointing deviation were significantly greater in the inexperienced neurosurgeons, especially with the microscope. Further analysis demonstrated that these differences were attributable to poorer depth perception of the phantom surgical space among the inexperienced neurosurgeons.