(1) Field of the Invention
The field of the invention relates to training devices useful for the teaching of the manipulation of laparoscopes. These training devices are especially useful for the development of skills that will allow a user to maintain a laparoscope in its proper orientation.
2) Description of the Related Art
Visualization of the surgical field is vital to the success of any operative procedure. In traditional open procedures, surgeons control the visualization of the operative field by their eye movements and by manipulation of lighting and retraction. However, this direct control is lost in the performance of laparoscopic surgery as the visualization becomes dependant on the ability of the assistant to navigate the laparoscope. Therefore, the ability of the assistant is pivotal to the success of the operation. This ability must include not only the utilization of a traditional 0°, straight viewing laparoscope, but also the utilization of an angled laparoscope. As laparoscopic procedures have become more complex and have moved from one-quadrant procedures to multi-quadrant procedures, use of the angled laparoscope has become increasingly more critical. Use of an angled laparoscope is advocated in splenctomy (Glasgow, 1999), Nissen fundoplication (Richardson, 1999), gastrectomy (Cuschieri, 2000), gastric bypass (Nguyen, 1999) (Schweitzer, 1999), adrenalectomy (Smith, 1999) and inguinal hernia repair (Ferzli 1995).
Although skilled laparoscopic camera navigation is critical for the success of a laparoscopic procedure, the first time most assistants hold a laparoscope is in the operating room. This can lead to a poor performance by the camera navigator causing frustration for both the camera navigator and the surgeon. To avoid this some surgeons utilize robotic systems for camera navigation.
Studies regarding the use of these robotic systems have met with mixed results. Some have shown a subjective surgeon preference for robotic camera control (Merola, 2002) (Omote, 1999) as well as some objective improvement in inadverdant movement (Kavoussi, 1995) and camera correction or cleaning (Omote, 1999). However when the robotic control was compared to a single experienced camera operator, no difference in surgeon efficiency was noted. (Kondraske, 2002) In one experimental task, manual control was quicker than robotic control (Jacobs, 1997) and both methods showed similar learning curves.
Therefore it is likely an experienced camera operator would be comparable to or better than a nonhuman operator since the experienced operator would require minimal direction from the surgeon, allow for the manipulation of the angle of the lens and perform the rapid changes needed in an acute event.
Laparoscopic camera navigation is often considered the easiest and least important task in the operating room but it can be difficult to master and includes the same barriers described in laparoscopic instrument manipulation, namely, the fulcrum effect (Gallagher, 1998), fixed access points (Jordan, 2001), a 2-demensional environment (Jones, 1996) and decreased range of motion. Skills unique to camera navigation, which must also be mastered, include centering of the operative field, smooth movements to avoid motion sickness, and tracking of instruments. The difficulty in skill acquisition is enhanced when an angled laparoscope is utilized. The rotation of the lens independent of the camera gives the ability to “look around corners” but to use this additional degree of freedom without change of horizon, steadiness or field of view is not intuitive and may be counter intuitive as moving the light cord up points the lens angle down.
Since camera navigation is perceived to be an easy task, the least experienced person in the operating room is often charged with this duty, which can lead to frustration. This frustration is compounded when the camera operator changes between cases, as is seen both in the academic arena with medical students rotating and in the private sector with different operating room technicians. Because of this inexperience, training usually occurs in the operating room but this has been shown to be inefficient and costly. This intra-operative training also requires surgeons to divide their attention between the operation and the manipulation of the camera.
Laparoscopic skills training outside the operating room has become more common and has been shown to translate to performance in the operating room. Despite this, training of camera navigation is not a laparoscopic skill widely taught outside of the operating room and there is no data, other than little virtual reality data (Hyltander, 2002) (Haluck, 2001), regarding training in laparoscopic camera navigation skills.
Virtual reality platforms have been used to teach camera navigation and have shown transfer of the skill to the operating room (Hyltander, 2002). However, these platforms have limitations including a hardware interface found to be inadequate for camera navigation simulation by 86% of subjects (Haluck, 2001). Additionally, a virtual reality platform would not allow camera navigation to be taught in some settings due to setup costs.