Toward improved communication in laparoscopic surgery: Accounting for multiple frames of reference and mental rotations

This work is an examination of barriers to communication between the attending and assisting surgeons during laparoscopic surgery, where the same image of the surgical site is viewed from different vantage points with respect to the patient. Part of the problem lies with the multiple frames of reference each surgeon holds, and the mental rotations each must perform to construct a common frame of reference for communication and collaborative work. An experiment was conducted to demonstrate the effects of display-control incongruency on the performance of an aiming task in a simulated laparoscopic environment. Aiming performance was best when the camera was oriented at 0° perspective and worsened as the angle of deviation from 0° increased. Performance was affected to a greater degree by viewing perspectives from the left of the subject than viewing perspectives from the right. Results also suggest that when surgeons are facing each other, as is the case in many laparoscopic surgeries, one surgeon's performance will be worse than the other's. The mismatched display-control perspectives are compounded by ambiguous spatial references in verbal communication. From these findings, a case can be made for the importance of vocabulary that forces a common frame of reference during laparoscopic surgery.