Simulated laparoscopy using a head-mounted display vs traditional video monitor: an assessment of performance and muscle fatigue

  • S. K. Maithel
  • L. Villegas
  • N. Stylopoulos
  • S. Dawson
  • D. B. Jones
Original article

Abstract

Background

The direction of visual gaze may be an important ergonomic factor that affects operative performance. We designed a study to determine whether a head-mounted display (HMD) worn by the surgeon would improve task performance and/or reduce muscle fatigue during a laparoscopic task when compared to the use of a traditional video monitor display (VMD).

Methods

Surgical residents (n = 30) were enrolled in the study. A junior group, consisting of 15 postgraduate year (PGY) = 1 subjects with no previous laparoscopic experience, and a senior group, consisting of 15 PGY 4 and PGY 5 subjects with experience, completed a laparoscopic task that was repeated four times using the Computer Enhanced Laparoscopic Training System (CELTS). Groups alternated between using the HMD with the task placed in a downward frontal position and the VMD with the task at a 30° lateral angle. The CELTS module assessed task completion time, depth perception, path length of instruments, response orientation, motion smoothness; the system then generated an overall score. Electromyography (EMG) was used to record sternocleidomastoid muscle activity. Display preference was surveyed.

Results

The senior residents performed better than the junior residents overall on all parameters (p < 0.05) except for motion smoothness, where there was no difference. In both groups, the HMD significantly improved motion smoothness when compared to the VMD (p < 0.05). All other parameters were equal. There was less muscle fatigue when using the VMD (p < 0.05). We found that 66% of the junior residents but only 20% of the senior residents preferred the HMD.

Conclusions

The CELTS module demonstrated evidence of construct validity by differentiating the performances of junior and senior residents. By aligning the surgeon’s visual gaze with the instruments, HMD improved smoothness of motion. Experienced residents preferred the traditional monitor display. Although the VMD produced less muscle fatigue, inexperienced residents preferred the HMD, possibly because of improved smoothness of motion.

Keywords

Computer Enhanced Laparoscopic Training System (CELTS) Laparoscopy Ergonomics Visual gaze Electromyography (EMG) 

Notes

Acknowledgments

This work was supported in part by an educational grant from Stryker Endoscopy. We thank Dr. Sanjeev Nandedkar for help and guidance with EMG acquisition and analysis. We are also grateful to Amie Goldberg for help with statistical data analysis

References

  1. 1.
    Arndt, R 1983Working posture and musculoskeletal problems of video display terminal operators-review and reappraisalAm Indus Hygiene Assoc44437446Google Scholar
  2. 2.
    Berguer, R 1997Surgical technology and the ergonomics of laparoscopic instrumentsSurg Endosc12458462CrossRefGoogle Scholar
  3. 3.
    Berguer, R, Rab, GT, Abu-Ghaida, H, Alarcon, A, Chung, J 1997A comparison of surgeons’ posture during lagaroscopic and open surgical proceduresSurg Endosc11139142CrossRefPubMedGoogle Scholar
  4. 4.
    Berguer, R, Forkey, DL, Smith, WD 1999Ergonomic problems associated with laparoscopic surgerySurg Endosc13466468CrossRefPubMedGoogle Scholar
  5. 5.
    Berguer, R, Chen, CY, Smith, WD 1999A virtual instrument ergonomics workstation, to measure surgeons’ physical stressStud Health Technol Inform624954PubMedGoogle Scholar
  6. 6.
    Berguer, R, Forkey, DL, Smith, WD 1999The effect of laparoscopic instrument working angle on surgeons’ upper extremity workloadSurg Enodosc1510271029Google Scholar
  7. 7.
    Berguer, R, Smith, WD, Chung, YH 2001Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgerySurg Endosc1512041207CrossRefPubMedGoogle Scholar
  8. 8.
    Cheah, WK, Lenzi, JE, So, J, Dong, F, Kum, CK, Goh, P 2001Evaluation of a head-mounted display (HMD) in the performance of a simulated laparoscopic taskSurg Endosc15990991CrossRefPubMedGoogle Scholar
  9. 9.
    Cotin, S, Stylopoulos, N, Dawson, S, Ottensmeyer, M, Neumann, P, Bardsley, R, Russel, M,  et al. 2003CELTS: a clinically-based Computer Enhanced Laparoscopic Training SystemStud Health Technol Inform94336342PubMedGoogle Scholar
  10. 10.
    Hanna, GB, Shimi, SM, Cuschieri, A 1998Task performance in endoscopic surgery is influenced by location of the image displayAnn Surg227481484CrossRefPubMedGoogle Scholar
  11. 11.
    Leoni, FMQ, Molle, F, Scavino, G, Dicknian, A 1994Identification of the preferential gaze position through evaluation of visual fatigue in a selected group of VDU operatorsDoc Ophthalmol87189197CrossRefPubMedGoogle Scholar
  12. 12.
    Menozzi, M, Buol, AV, Miege, C 1994Direction of gaze and comfort: discovering the relation for the ergonomic optimization of visual tasksOphthal Physiology14393399CrossRefGoogle Scholar
  13. 13.
    Nguyen, NT, Ho, HS, Smith, WD, Philipps, C, Lewis, C, DeVera, RM, Berguer, R 2001An ergonomic evaluation of surgeons’ axial skeletal and upper extremity movements during laparoscopic and open surgeryAm J Surg182720724CrossRefPubMedGoogle Scholar
  14. 14.
    Smith, WD, Chung, YH, Berguer, R 2000A virtual instrument ergonomics workstation for measuring the mental workload of performing video-endoscopic surgeryStud Health Technol Inform70309315PubMedGoogle Scholar
  15. 15.
    Stylopoulos, N, Cotin, S, Maithel, SK, Ottensmeyer, M, Jackson, P, Bardsley, R, Neumann, P,  et al. 2004Computer Enhanced Lapagoscopic Training System (CELTS): bridging the gapSurg Endosc18782789CrossRefPubMedGoogle Scholar
  16. 16.
    VanKoesveld, JJM, Tetteroo, GWM, deGraff, EJR 2003Use of head-mounted display in transanal endoscopic microsurgerySurg Endosc17943946CrossRefPubMedGoogle Scholar
  17. 17.
    Veelen, MA, Kazemier, G, Koopman, J, Goossens, RH, Meijer, DW 2002Assessment of the economically optimal operating surface height for laparoscopic surgeryJ Laparoendosc Adv Surg Tech124752CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • S. K. Maithel
    • 1
    • 4
  • L. Villegas
    • 4
  • N. Stylopoulos
    • 2
  • S. Dawson
    • 2
    • 3
  • D. B. Jones
    • 1
    • 2
    • 4
  1. 1.Department of Minimally Invasive SurgeryBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Center for Integration of Medicine and Innovative Technology (CIMIT)BostonUSA
  3. 3.Department of RadiologyMassachusetts General HospitalBostonUSA
  4. 4.Harvard Center for Minimally Invasive SurgeryBostonUSA

Personalised recommendations