Performance Carry-Over Effects Caused by Exposure to Multiple Visuo-Spatial Distortions in a Laparoscopic Training Environment

Abstract

Laparoscopic surgeries entail a camera being inserted into the body that projects the surgical field onto a monitor. This process introduces visuo-motor distortions, as surgeons need to view the tissue from the camera’s perspective. These distortions get worse when the camera cannot be aligned with the axis which would form the normal line of sight. Prior research suggested two adaptation mechanisms under such conditions. A gradual adaptation mechanism is observed where off-axis rotations are less than 90°, requiring more time to adapt as the distortion increases. Relatively superior performance at 180° has been attributed to an axis inversion mechanism. An axis inversion followed by gradual backward adaptation has been hypothesized when rotations fall between 90° and 180°. When surgeons must use multiple camera perspectives, exposure to prior rotations might impact motor performance. We hypothesized beneficial carry-over effects when rotations are both above or below the 90° threshold as both rely on the same adaptation mechanisms. Consistent with our hypotheses, we observed tendencies for improved performance below the threshold. However, the carry-over effects for rotations separated by the threshold were mixed. For successive rotations above the threshold, no beneficial carry-over effects were observed, which might be due to a floor effect.