Image converter eliminates mirror imaging during laparoscopy

William K. Johnston, Roger Low, Sakti Das

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background and Purpose: In laparoscopy, the term "mirror imaging" is used to describe a visual illusion resulting in paradoxical movements when a surgeon is positioned opposite the laparoscope. Mirror imaging is a common problem, creating difficulty in ergonomics and task performance. We introduce the use of a video image converter box (IC box) to overcome mirror imaging. The IC box converts the analog signal to a digital one, performs image rotation or inversion or both, and then reproduces an analog signal for monitor viewing. A laboratory study evaluated whether the IC box could improve performance during laparoscopic tasks. Materials and Methods: Fourteen laparoscopic surgeons (10 novice and 4 experienced) completed three laparoscopic tasks while positioned opposite the camera and experiencing mirror imaging: (1) suture cutting; (2) multiple transfers of a piece of foam; and (3) multiple transfers of a pinto bean. Participants were timed during each test both with and without the use of the IC box. Results: All surgeons completed each task faster using the IC box (P < 0.015). On average, use of the IC box allowed subjects to complete assignments in less than one-third the time needed without the IC box. In Task 3, requiring multiple transfers of a small bean, all participants using the IC box completed the task. However, without the box, only 1 of 14 participants accomplished the goal in the allotted time. Conclusion: Use of the IC box eliminates mirror imaging and improves performance and efficiency during laparoscopic tasks. The box would significantly benefit surgeons positioned opposite the camera during laparoscopic surgery.

Original languageEnglish (US)
Pages (from-to)327-331
Number of pages5
JournalJournal of Endourology
Issue number5
StatePublished - Jun 2003

ASJC Scopus subject areas

  • Urology


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