Surgical Endoscopy

, Volume 32, Issue 3, pp 1174–1183 | Cite as

Impact of visual–spatial ability on laparoscopic camera navigation training

  • Paul J. Roch
  • Henriette M. Rangnick
  • Julia A. Brzoska
  • Laura Benner
  • Karl-Friedrich Kowalewski
  • Philip C. Müller
  • Hannes G. Kenngott
  • Beat-Peter Müller-Stich
  • Felix Nickel



Technical limitations of minimally invasive surgery challenge both surgeons and camera assistants. Current research indicates that visual–spatial ability (VSA) has impact on learning of laparoscopic camera navigation (LCN). However, it remains unclear if complexity of LCN tasks influences the impact of VSA. The aim of this study was to examine the influence of VSA on LCN training within tasks of different complexity levels.


The present study was conducted as a monocentric prospective trial. VSA was assessed with a cube comparison test before participants underwent LCN training. LCN training consisted of three tasks with increasing complexity. Each task was performed four times and performance was assessed each time. Correlations and multivariate regression analysis were used to assess the influence of VSA on LCN skills.


Seventy-one participants were included (35 males). Significant performance improvement and faster completion times were observed from the first to fourth trial of all three LCN training tasks. Significant positive correlations between VSA and performance on LCN task 3 were found (performance: r s = 0.47; p < 0.001, time: r s = −0.43; p < 0.001). Multivariate regression revealed that higher VSA resulted in greater reduction of time between the first trials of LCN training task 3 (B = −1.67, p = 0.031).


In the present study, all trainees improved LCN performance during the training. VSA seems to have impact on LCN performance and training progress particularly for complex LCN tasks. The relation of VSA and LCN performance was stronger for less experienced participants and in the beginning of the learning phase.


Visual–spatial ability Laparoscopy Camera navigation Skills Training Complex tasks 



Minimally invasive surgery


Laparoscopic camera navigation


Visual–spatial ability


Virtual reality



We would like to thank Sarah Trent for proofreading the manuscript. We would like to thank Marion Link for her help with organizing this study.


The current study was supported by the Heidelberg Surgery Foundation and by the Ministry of Science and Arts of the State Baden Wurttemberg.

Author contributions

Study conception and design: Nickel, Kenngott, Rangnick, Müller-Stich. Acquisition of data: Nickel, Rangnick, Brozska, Müller, Müller-Stich. Statistical analysis: Benner, Roch, Rangnick, Nickel, Kenngott. Analysis and interpretation of data: Roch, Nickel, Müller, Brozska, Kowalewski. Drafting of manuscript: Roch, Rangnick, Nickel, Kowalewski. Critical revision: Müller-Stich, Nickel. All authors read and approved the final version of this manuscript.

Compliance with ethical standards


Felix Nickel reports receiving travel support for conference participation as well as equipment provided for laparoscopic surgery courses by KARL STORZ, Johnson & Johnson, and Medtronic. Paul J. Roch, Henriette M. Rangnick, Julia A. Brzoska, Laura Benner, Philip C. Müller, Hannes G. Kenngott, Beat-Peter Müller-Stich, and Felix Nickel have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Paul J. Roch
    • 1
  • Henriette M. Rangnick
    • 2
  • Julia A. Brzoska
    • 1
  • Laura Benner
    • 3
  • Karl-Friedrich Kowalewski
    • 1
  • Philip C. Müller
    • 1
  • Hannes G. Kenngott
    • 1
  • Beat-Peter Müller-Stich
    • 1
  • Felix Nickel
    • 1
  1. 1.Department of General, Visceral, and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Department for Visceral, Thoracic and Vascular Surgery at the University HospitalTechnical University DresdenDresdenGermany
  3. 3.Institute for Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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