Learning to use minimal access surgical instruments and 2-dimensional remote visual feedback: How difficult is the task for novices?

Performing minimal access surgery requires the use of 2-dimensional information to produce 3-dimensional movements, as well as precise motor control for manipulating laparoscopic tools. The added visuomotor demands of this task make it more demanding and complex than traditional open surgery. The purpose of this study was to determine the relative task difficulty of performing laparoscopic tool movements with normal vision or `laparoscopic vision' provided by a remote 2-D monitor. A second purpose of this study was to evaluate whether movement performance changes are induced by practice with normal vision (NV) and laparoscopic vision (LV). The study was also designed to determine whether order of visual condition (NV or LV) practice impacts the rate of performance acquisition when transferred to the opposing visual condition. Eleven individuals participated in this study. All subjects performed a bean grasping and a suturing task in two visual conditions: normal vision and laparoscopic vision. Results revealed that laparoscopic tools themselves do not appear to be problematic in performing minimal access surgery. Furthermore, performance ability in normal vision does not positively transfer to performance when switched to a laparoscopic vision condition. The 2-dimensional video does appear to be problematic for skill acquisition, as performance levels decreased as complexity of the task increased.