Disorientation in minimal access surgery: A case study

Navigating through minimal access surgical environments such as the human colon can be difficult, even for expert gastroenterologists. "Getting lost" is a common experience for endoscopists, especially within the tortuous sigmoid colon where salient landmarks are not generally available. This paper presents the concept of "getting lost" in endoscoppy as a loss of both global and local spatial orientation. For the endoscopist performing a colonoscopy, the consequence of local disorientation is an inability to continue the procedure, or possibly even injury to the patient, while consequences of global disorientation can be mistaking the location of a lesion, and/or incomplete examination, resulting in misdiagnosis. This study provides important insights into the physical and cognitive constraints of the task of navigating in colonoscopy, contributing to disorientation in the colon. The implications of our findings for the design of navigational aids and training tools are also discussed.