A model to characterise re-orientation strategies in natural orifice translumenal endoscopic surgery

Navigating using an endoscope in intraor extra-lumenal surgical procedures can be difficult. One of the main reasons why this is difficult is operator disorientation. Operator disorientation can result from a number of factors including a lack of navigational cues, cognitive overload and restricted field of view of the endoscope. These result in decreased operator awareness of surroundings and the endoscope location in space. It is important to try to prevent operator disorientation in endoscopic procedures; however, it is equally important to efficiently and correctly re-orientate when disorientated to ensure safe surgery. It is likely that as endoscopic procedures are carried out extralumenally in greater spatial environments than the gastrointestinal tract, such as in natural orifice translumenal endoscopic surgery (NOTES), disorientation will become more of a problem, placing greater emphasis on the abilities of the operator to re-orientate efficiently. The hypothesis is that when humans are disorientated there exist discrete patterns in psychophysical visual behaviour used to re-orientate themselves in this simulated NOTES environment. These patterns are associated with increased performance and can be quantified or described. Should this be the case, it would seem possible that these strategies may be taught to re-orientate more effectively during minimally invasive surgery thereby critically minimising danger to the patient should the operator becomes disorientated.