Using multiple ports to learn visuomotor transformations could reduce the risk of human error in laparoscopic surgery

Abstract

Laparoscopic surgery is a complex visuomotor task that takes many years to master. Surgeons have to manipulate long laparoscopic tools inserted through access ports in the abdomen wall whilst viewing the tools and workspace on a remote visual display (via an endoscopic camera) (see Figure 1, sup material). This decoupling of motoric workspace and visual display creates distorted visuomotor mappings which varies with camera and port position: when the port position is changed, different limb movements and forces are required to elicit the same visual outcome (the tools are 1[sup]st[/sup] order sliding levers). It has been shown that exposure to a variety of visuomotor distortions improves learning of novel visuomotor mappings (Braun et al., 2009), however, it is not clear whether this finding generalises to the laparoscopic surgical environment. To investigate this we trained two groups of surgically naive participants on an aiming task using a laparoscopic training box. Participants used a laparoscopic tool to trace along the surface of a digitising tablet to control a visual cursor on a vertical display. Participants made movements to sequentially appearing targets and were instructed to move as fast and accurately as possible. One group was trained to complete this task by using only a single port, while the other group trained with three different ports. Both groups were then tested using a novel port the same distance from all training ports. Our findings revealed that exposure to multiple ports significantly improved performance when using the novel port (see Figure 2, sup material). This suggests the CNS is able to use information about multiple visuomotor mappings arising from port positions in order to improve future performance. Consequently we propose that visuomotor variation should be built into surgical training systems in order to reduce the risk of human error during clinical practise.

Meeting abstract presented at VSS 2013