Evaluation of laparoscopic performance with alteration in angle of vision

Background and Purpose: Optimal placement allows intuitive laparoscope positioning between two working trocars (0° angle). However, this configuration may require the assistant to operate in an awkward position. We evaluated the effect of alteration of laparoscope position on surgeon performance and correlated this with surgical experience. Subjects and Methods: Participants were stratified by laparoscopic experience. Group 1 (N = 10) was naive (no surgical experience), group 2 (N = 7) had moderate laparoscopic experience (1-100 cases), and group 3 (N = 6) was laparoscopically experienced (>100 cases). Participants were timed performing a simple laparoscopic task three times in a trainer with camera angles randomized along the horizontal plane: 0°, 45°, 90°, 135°, and 180°. Results: All participants showed progressive deterioration in performance as the angle deviated from baseline. The mean time required to complete the tasks was significantly higher for group 1 v groups 2 and 3 at 135° (158 v 77 and 73 seconds) and 180° (153 v 89 and 86 seconds). Performance curves for each group revealed more pronounced deterioration of performance with alteration in the angle of vision in group 1 than in groups 2 and 3 (P < 0.01). There was no difference between groups 2 and 3 (P = 0.19). Conclusions: Even modest alteration in laparoscopic perspective results in deterioration of performance for all levels of surgical experience. Experienced laparoscopists adapt more quickly to complexities presented by alteration in camera angles. Novice surgeons should focus on trocar positioning to maintain intuitive surgical perspective and should refrain from working with alterations in camera angles until significant laparoscopic experience has been gained.