Does the Lens Deflection Angle Affect Laparoscopic Camera Navigation?

In laparoscopic surgery, a 30° lens is frequently used to obtain a wider field of view. However, it is difficult for inexperienced surgeons to maintain the horizontal state of the image in laparoscopic camera navigation (LCN). If there is a great deviation in the camera's horizontal axis, it may result in ambiguous anatomical recognition, which could impair patient safety. Scientific assessment of the degree of camera's horizontal axis deflection in camera holders with differing proficiencies is necessary for improving novice surgeons' fundamentals of laparoscopic surgery. This study aims to develop an evaluation and training system based on the deflection angle (refers to the change in the angle of the camera axis from its preset vertical position) and assess its potential value in the training and clinical application of laparoscopic surgery. A total of 15 postgraduates without laparoscopic surgery experience and 15 skilled senior attending physicians with an experience in more than 50 cases of laparoscopic surgery were recruited. The participants completed an LCN exercise. An inclinometer module was used to measure the camera's horizontal axis deflection angle and the difference in the deviation angle was compared between the two groups. A deflection angle greater than ±15° was found in 57.98% and 31.76% of participants in the novice group and skilled group, respectively, whereas a deflection angle greater than ±30° was found in 18.4% and 7.58% of participants in the novice group and the skilled group, respectively. The thresholds (we designate 15°, 30°, 45°, and 60° as the checkpoints) for all angles were significantly different for the two groups. There was a significant difference in the technique of maintaining the camera's horizontal axis within an acceptable range between the novice and the skilled participants. Training that focuses on this deflection angle may be helpful for novice camera holders.