Development of a novel simulation model for assessment of laparoscopic camera navigation



Laparoscopic camera navigation is vital to laparoscopic surgery, yet often falls to the most junior member of the surgical team who has limited laparoscopic operating experience. Previously published reports on simulation models fail to address qualitative scoring of movement, method of communication and correct physician location with respect to patient position. The purpose of this study was to develop and evaluate a novel laparoscopic camera navigation simulation model that addresses these deficiencies.


A novel, low-cost laparoscopic camera navigational maze was constructed from pliable foam for use in a standard laparoscopic surgery box trainer. Participants (n = 37) completed a camera navigation exercise by following a pre-recorded set of verbal instructions using correct anatomic terminology that is used in the operating room, to simulate an actual operating room experience of receiving verbal cues from senior surgeons. The sample group consisted of participants at various levels of Obstetrics and Gynecology training, representing novice to expert laparoscopists. Each trial was recorded with a multi-channel video camera. Performances were scored by a blinded evaluator for excess gross and fine camera movements as well as overt errors, including camera collisions and failure to follow directions.


Our model demonstrated evidence of validity by discriminating performance by level of laparoscopic experience with a statistically significant decrease in number of movements and errors in experts compared to novices. A trend emerged toward improvement with each additional year of training, with reduced variability among performances in more experienced participants.


This novel, low-cost box-trainer simulation model for laparoscopic camera navigation offers a mechanism for assessment of laparoscopic camera operation skills. Moreover, this model closely replicates operating room logistics and communication. Given the necessity for improved laparoscopic camera operation education, our model represents a unique, complementary tool to other laparoscopic simulation curricula.

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Study funding was provided by individual donor support to the simulation program at the University of Michigan. We would like to acknowledge the Kramer and Goldberg families for the support of our simulation program. Their donation provided an unrestricted fund for use in simulation research and was not limited to our study.

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Correspondence to Melissa W. Brackmann.

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We have no other financial relationships to disclose. Melissa Brackmann, Pamela Andreatta, Karen McLean, R Kevin Reynolds have no conflicts of interest to disclose.

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MPEG, Comparison of a novice and expert laparoscopist navigating our laparoscopic camera maze utilizing fixed audio cues (MPEG 182182 kb)

Supplementary Video 1

MPEG, Comparison of a novice and expert laparoscopist navigating our laparoscopic camera maze utilizing fixed audio cues (MPEG 182182 kb)

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Brackmann, M.W., Andreatta, P., McLean, K. et al. Development of a novel simulation model for assessment of laparoscopic camera navigation. Surg Endosc 31, 3033–3039 (2017) doi:10.1007/s00464-016-5323-x

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  • Simulation
  • Laparoscopic camera navigation
  • Surgical education