Author Affiliations: Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, St Mary's Hospital, Paddington, London, England.
Given that the first laparoscopic cholecystectomy was only performed in 1985,1 the growth of technology and innovation in minimally invasive surgery (MIS) since then has been truly exponential. Today, we can perform operations through a single incision in the umbilicus or through a natural orifice such as the vagina, leaving no visible scars, and major operations such as colonic resections are now routinely performed laparoscopically. With the drive for natural orifice translumenal endoscopic surgery (NOTES), clinicians are actively waiting for further engineering innovation to provide solutions to problems such as a stable platform for navigation and instrument triangulation prior to mainstream clinical uptake. With advances in engineering, there is a whole array of new challenges facing the surgeon. The 2-dimensional user interface used in MIS degrades visual cues such as depth perception, coupled with a decrease in sensory feedback and a limited visual display. These are some of the many features that can lead to an increased cognitive load on the surgeon and make the operator more prone to disorientation.
Sodergren M, Yang G, Darzi LA. Perception and Orientation in Minimally Invasive Surgery. Arch Surg. 2012;147(3):210-211. doi:10.1001/archsurg.2011.2037