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George B. Hanna, PhD; Adrian B. Cresswell, MB, ChB; Alfred Cuschieri, FRSE

Arch Surg. 2002;137:1166-1169.

Hypothesis  A shadow-inducing laparoscopic system improves task performance.

Design  Experimental study was carried out using the Dundee Endoscopic Psychomotor Tester for objective assessment of task performance. The standard exercise consisted of passing a probe through 37 holes on the target plate in a random order. Shadow was induced by using separate ports for illumination and imaging of the target plate. Light direction–to–target (LDT) angles of 90°, 75°, and 60° were investigated with each of the 90° and 75° optical axis–to–target view angles.

Setting  Research laboratory at the Surgical Skills Unit, Ninewells Hospital.

Participants  Twenty medical students with no previous exposure to laparoscopic surgery.

Main Outcome Measures  Success score, execution time, the force applied on the target, and angular deviations of the probe.

Results  With a 90° optical axis–to–target angle, there was improvement in the success score using either 75° or 60° LDT angles compared with a 90° LDT angle (P = .02, P = .01, respectively), but the execution time became longer (P = .008, P = .03, respectively). With a 75° optical axis–to–target angle, there was improvement in the success score (P<.001), execution time (P<.001, P = .03, respectively), and horizontal and vertical deviations (P<.001) on using either 90° or 60° LDT angles compared with a 75° LDT angle.

Conclusion  Endoscopic task performance significantly improves with a system that provides illumination and shadows in the operative field.

From the Department of Surgery and Molecular Oncology and the Surgical Skills Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland.

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