Camera navigation and tissue manipulation; are these laparoscopic skills related?

It is a tacit assumption that clinically based expertise in laparoscopic tissue manipulation entails skilfulness in angled laparoscope navigation. The main objective of this study was to investigate the relation between these skills. To this end, face and construct validity had to be established for the place arrow (PA) and camera navigation (CN) tasks on the SimSurgery SEP. Thirty-three novices (no laparoscopy experience) and 33 experienced participants (> 50 laparoscopic procedures and familiar with angled laparoscopy) performed both tasks twice, on one of two hardware platforms (SimSurgery SimPack or Xitact/Mentice IHP), and rated the realism and didactic value of SimSurgery SEP on five-point scales. Both tasks were rated by the experienced participants as realistic (CN: 3.7; PA: 4.1) and SimSurgery SEP as a user-friendly environment to train basic skills (4.1). Both tasks were performed in less time by the experienced group, with shorter tip trajectories. For both groups jointly, the time to accomplish each task correlated with the tip trajectory and also with the time and tip trajectories of the opposite task (Spearman's correlation, p a parts per thousand currency sign 0.05). Within the groups however, the performances on both tasks did not always correlate. A correlation was not always found between the performances on the two tasks, which suggests that clinically based expertise in tissue manipulation does not automatically entail skilfulness in angled laparoscope navigation, and vice versa. Training and assessment of basic laparoscopic skills should focus on these tasks independently. More research is needed to better identify the skills and required proficiency levels for different laparoscopic tasks.