Experienced laparoscopic surgeons are automated to the "fulcrum effect": An ergonomic demonstration

Background and Study Aims: The inversion of the normal laparoscopic image a round the Y-axis has been shown to facilitate the rate of learning of a lap aroscopic task in novice subjects. The aim of this study was to investigate the effect of Y-axis image inversion on the performance of experienced lap aroscopic surgeons; this had not been previously investigated. Methods: A total of 16 experienced surgeons,who had already carried out mor e than 50 operative laparoscopic procedures, and 16 novice participants, wh o had carried out no procedures, were required to make multiple defined inc isions under laparoscopic laboratory conditions within ten 1-minute periods . Participants were randomly allocated to perform the task under either nor mal or Y-axis inverted imaging conditions (eight experienced surgeons and e ight novices in each condition). Results: Y-axis inversion had a significant detrimental effect on the perfo rmance of the surgeons, whilst facilitating the performance of novices. The surgeons however, adapted to the inverted condition rapidly, showing a sig nificant improvement in performance over the ten trials, Conclusions: The Y-axis-inverted image has a detrimental effect on the perf ormance of experienced surgeons, indicating that they have automated to the "fulcrum effect" of the abdominal wall on instrument manipulation. Y-axis- image inversion was found to facilitate significant learning trends, regard less of the participants' level of experience.