Effect of Mirrored Views on Endoscopic and Arthroscopic Skill Performance

BACKGROUND: Arthroscopic procedures may be technically challenging because of impaired vision, limited space, and the 2-dimensional vision of a 3-dimensional structure. Spatial orientation may get more complicated when the camera is pointing toward the surgeon. HYPOTHESIS: Spatial orientation and arthroscopic performance may be improved by simply mirroring the image on the monitor in different configurations regarding the position and orientation of camera and instrument. STUDY DESIGN: Descriptive laboratory study. METHODS: Thirty volunteers from an orthopaedic department were divided into 3 equal groups according to their arthroscopic experience (beginners, intermediates, seniors). All subjects were asked to perform a standardized task in a closed box mimicking an endoscopic space. The same task had to be performed in 4 different configurations regarding camera and instrument position and orientation (pointing toward or away from the subject) with either the original or mirrored image on the monitor. Efficiency (time per stick; TPS), precision (successful completion of the task), and difficulty rating using a visual analog scale (VAS) were analyzed. RESULTS: Mirroring the image demonstrated no advantage over the original images in any configuration regarding TPS. Successful completion of the task was significantly better when the image was mirrored in the configuration with the camera pointing toward and the instrument away from the surgeon. There was a positive correlation between TPS and subjective VAS difficulty rating (r = 0.762, P = .000) and a negative correlation between the successful completion of the task and VAS (r = −0.515, P = .000). CONCLUSION: Mirroring the image may have a positive effect on arthroscopic performance of surgeons in certain configurations. A significantly improved performance was seen when the arthroscope was pointing toward and the grasping instrument pointing away from the subject. Mirroring the image may facilitate surgery in such clinical situations. CLINICAL RELEVANCE: Mirroring the image may facilitate arthroscopic procedures in certain clinical situations.