Epistemology of visual imaging in endoscopic surgery.

Little work has been done on aspects of visual perception and related defects as they affect the proficiency level for endoscopic surgery, in which the surgeon must operate from images rather than reality (indirect perception). Newer metrics of image quality should be used to assess image displays for endoscopic surgery because they provide more objective data. Ergonomic considerations relating to operations from images have likewise been inadequately researched. The monitor optimal working distance is highly variable from surgeon to surgeon. This problem could be overcome easily by the use of floor markings. Data from visual ergonomic experimental studies indicate that the best performance in endoscopic surgery is obtained by frontal gaze-down viewing because this restores the alignment of the visual with the motor axes of the operator.