Image converter eliminates mirror imaging during laparoscopy

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.