Sensorimotor Challenges in Minimally Invasive Surgery: A Theoretically-Oriented Review

Abstract

Objective: This review surveys the literature on sensorimotor challenges impacting performance in laparoscopic minimally invasive surgery (MIS).

Background: Despite its well-known benefits for patients, achieving proficiency in MIS can be challenging for surgeons due to many factors including altered visual perspectives and fulcrum effects in instrument handling. Research on these and other sensorimotor challenges has been hindered by imprecise terminology and the lack of a unified theoretical framework to guide research questions in the field.

Method: We conducted a systematic survey of the MIS literature, focusing on studies investigating sensorimotor challenges affecting laparoscopic performance. To provide a common foundation for cross-study comparisons, we propose a standardized taxonomy that distinguishes between different experimental paradigms used in the literature. We then show how the computational motor learning perspective provides a unifying theoretical framework for the field that can facilitate progress and motivate future research along clearer, hypothesis-driven lines.

Results: The survey identified diverse sensorimotor perturbations in MIS, which can be effectively categorized according to our proposed taxonomy. Studies investigating monitor-, camera-, and tool-based perturbations were systematically analyzed, elucidating their impact on surgical performance. We also show how the computational motor learning perspective provides deeper insights and potential strategies to mitigate challenges.

Conclusion: Sensorimotor challenges significantly impact MIS, necessitating a systematic, empirically informed approach. Our proposed taxonomy and theoretical framework shed light on the complexities involved, paving the way for more structured research and targeted training approaches to enhance surgical proficiency.

Application: Understanding the sensorimotor challenges inherent to MIS can guide the design of improved training curricula and inform the configuration of setups in the operating room to enhance surgeon performance and ultimately patient outcomes. This review offers key insights for surgeons, educators, and researchers in surgical performance and technology development.

Keywords: medical simulation/training and assessment; motor control; motor learning; performance; sensorimotor-adaptation; simulation and training; skilled; surgical training.

Figure 1.

Open surgery compared to the different types of sensorimotor perturbations experienced in MIS. (a) In open surgery, the native reference frame of vision and the physical workspace are closely, if not perfectly, aligned. (b) In laparoscopic surgery, monitor-based sensorimotor perturbations arise from translational and rotational displacements of the monitor (where visual feedback is provided) relative to the physical workspace. (c) Camera-based perturbations arise from displacements of the laparoscopic camera (roll, pitch, yaw) relative to the physical workspace, especially the movement plane. (d) Tool-based perturbations arise from the complex motion of laparoscopic instruments or tools such as when hand motion is inverted relative to instrument tip motion. Solid arrows indicate hand movement directions and dashed arrows indicate instrument tip movement directions. Colors indicate paired instrument tip movements. Only the surgeon is shown. However, the camera operator faces similar challenges, which in turn compound the challenges facing the surgeon.

Figure 2.

Flow of review process.

Figure 3.

Different views of the MIS experimental workspace. (a–e) Workspace and camera positions for experimental paradigms probing the influence of camera roll angle changes on motor performance. Panels from left to right depict side view, overhead view, and camera views (0° roll, 90° roll, 180° roll), respectively. (f–j) Workspace and camera positions for experimental paradigms probing the influence of camera yaw angle changes on motor performance. Panels from left to right depict side view, overhead view, and camera views (0° yaw, 90° yaw, 180° yaw), respectively. (k–o) Workspace and camera positions for experimental paradigms probing the influence of camera pitch angle changes on motor performance. Panels from left to right depict side view, overhead view, and camera views (30° pitch, 45° pitch, 60° pitch), respectively.