Background: Effective camera handling is fundamental to laparoscopic surgery, yet structured training in camera angulation is often underemphasized in early Minimal Invasive Surgery (MIS) education. This randomized controlled study evaluated the impact of angle-specific simulation training on novice performance across three clinically relevant trocar entry points. Methods: Twenty medical trainees with no prior MIS experience were randomized to a simulation-trained group or a theory-only control group. The study group completed fifteen structured sessions (five per angle), while controls received only a baseline lecture. All participants performed standardized bean-transfer tasks under Umbilical, Palmer’s Point, and Lee-Huang angles. Outcomes included task completion time, error patterns, and camera stability; subjective ratings assessed visualization and spatial orientation. Semi-structured interviews explored cognitive adaptation. Results: Sixteen participants completed the study. The simulation group achieved significantly faster task times across all five sessions compared with controls (all p Conclusion: Structured camera-angle simulation training significantly enhances speed, accuracy, and stability in laparoscopic visualization tasks, while improving novices’ spatial orientation and confidence. Early integration of angle-specific modules into MIS curricula may accelerate visuospatial readiness and improve foundational operative skills.
KeywordsLaparoscopic TrainingCamera AngulationSimulation-Based EducationMinimally Invasive Surgery
Jeganathan, J.R., Jegasothy, R. and Sia, W.T. (2025) Minimally Invasive Surgery: A Historical and Legal Perspective on Technological Transformation. Journal of Robotic Surgery , 19, Article No. 408. https://doi.org/10.1007/s11701-025-02589-7
Bogdanova, R., Boulanger, P. and Zheng, B. (2016) Depth Perception of Surgeons in Minimally Invasive Surgery. Surgical Innovation , 23, 515-524. https://doi.org/10.1177/1553350616639141
Raje, S., Sinha, R. and Rao, G. (2017) Three-Dimensional Laparoscopy: Principles and Practice. Journal of Minimal Access Surgery , 13, 165-169. https://doi.org/10.4103/0972-9941.181761
Colan, J., Davila, A. and Hasegawa, Y. (2022) A Review on Tactile Displays for Conventional Laparoscopic Surgery. Surgeries , 3, 334-346. https://doi.org/10.3390/surgeries3040036
Supe, A.N., Kulkarni, G.V. and Supe, P.A. (2010) Ergonomics in Laparoscopic Surgery. Journal of Minimal Access Surgery , 6, 31-36. https://doi.org/10.4103/0972-9941.65161
Lusch, A., Bucur, P.L., Menhadji, A.D., Okhunov, Z., Liss, M.A., Perez-Lanzac, A., et al . (2014) Evaluation of the Impact of Three-Dimensional Vision on Laparoscopic Performance. Journal of Endourology , 28, 261-266. https://doi.org/10.1089/end.2013.0344
Beane, M. (2019) Shadow Learning: Building Robotic Surgical Skill When Approved Means Fail. Administrative Science Quarterly , 64, 87-123. https://doi.org/10.1177/0001839217751692
Zakeri, Z., Mansfield, N., Sunderland, C. and Omurtag, A. (2020) Physiological Correlates of Cognitive Load in Laparoscopic Surgery. Scientific Reports , 10, Article No. 12927. https://doi.org/10.1038/s41598-020-69553-3
van Kesteren, J., van Goudoever, L.A.E., Conteh, A., van Acker, G.J.D., Bonjer, H.J. and Bolkan, H.A. (2023) Technical Perspective for Video Based Assessment of Surgeries in Low-Resource Settings. Journal of Surgical Education , 80, 495-498. https://doi.org/10.1016/j.jsurg.2023.01.003
Elendu, C., Amaechi, D.C., Okatta, A.U., Amaechi, E.C., Elendu, T.C., Ezeh, C.P., et al . (2024) The Impact of Simulation-Based Training in Medical Education: A Review. Medicine ( Baltimore ), 103, e38813. https://doi.org/10.1097/md.0000000000038813
Topalli, D. and Cagiltay, N.E. (2018) Eye-Hand Coordination Patterns of Intermediate and Novice Surgeons in a Simulation-Based Endoscopic Surgery Training Environment. Journal of Eye Movement Research , 11, 1-14. https://doi.org/10.16910/jemr.11.6.1
Siddharth, A., Mastoridis, S., Silva, M., Aitken, D. and Higham, H. (2025) Exploring Trainee Experiences in a Structured Virtual Reality Laparoscopic Training Programme for General Surgeons: A Longitudinal Case Study. Advances in Simulation , 10, Article No. 54. https://doi.org/10.1186/s41077-025-00359-x
Zendejas, B., Brydges, R., Hamstra, S.J. and Cook, D.A. (2013) State of the Evidence on Simulation-Based Training for Laparoscopic Surgery. Annals of Surgery , 257, 586-593. https://doi.org/10.1097/sla.0b013e318288c40b
Moè, A. (2016) Teaching Motivation and Strategies to Improve Mental Rotation Abilities. Intelligence , 59, 16-23. https://doi.org/10.1016/j.intell.2016.10.004
Seymour, N.E., Gallagher, A.G., Roman, S.A., O’Brien, M.K., Bansal, V.K., Andersen, D.K., et al . (2002) Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study. Annals of Surgery , 236, 458-464. https://doi.org/10.1097/00000658-200210000-00008
Van Sickle, K.R., Ritter, M.E., Baghai, M., Goldenberg, A.E., Huang, I., Gallagher, A.G., et al . (2008) Prospective, Randomized, Double-Blind Trial of Curriculum-Based Training for Intracorporeal Suturing and Knot Tying. Journal of the American College of Surgeons , 207, 560-568. https://doi.org/10.1016/j.jamcollsurg.2008.05.007
Hopewell, S., Chan, A., Collins, G.S., Hróbjartsson, A., Moher, D., Schulz, K.F., et al . (2025) CONSORT 2025 Statement: Updated Guideline for Reporting Randomized Trials. Nature Medicine , 31, 1776-1783. https://doi.org/10.1038/s41591-025-03635-5
Wang, X., Li, Y., Cai, Y., Meng, L., Cai, H., Liu, X., et al . (2018) Laparoscopic Suture Training Curricula and Techniques. Annals of Translational Medicine , 6, Article No. 215. https://doi.org/10.21037/atm.2018.05.17
Seymour, N.E., Nepomnayshy, D., De, S., Banks, E., Breitkopf, D.M., Campagna, R., et al . (2023) What Are Essential Laparoscopic Skills These Days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee Technical Skills Survey. Surgical Endoscopy , 37, 7676-7685. https://doi.org/10.1007/s00464-023-10238-z
Miles, S. and Donnellan, N. (2022) Learning Fundamentals of Laparoscopic Surgery Manual Skills: An Institutional Experience with Remote Coaching and Assessment. Military Medicine , 187, e1281-e1285. https://doi.org/10.1093/milmed/usab170
Marlow, N., Altree, M., Babidge, W., Field, J., Hewett, P. and Maddern, G.J. (2014) Laparoscopic Skills Acquisition: A Study of Simulation and Traditional Training. ANZ Journal of Surgery , 84, 976-980. https://doi.org/10.1111/ans.12282
Kim, C.H., Lee, J., Lee, S.Y., Heo, S.H., Jeong, Y.Y. and Kim, H.R. (2022) Periumbilical Transverse Incision for Reducing Incisional Hernia in Laparoscopic Colon Cancer Surgery. World Journal of Surgery , 46, 916-924. https://doi.org/10.1007/s00268-021-06319-6
Tüfek, I., Akpınar, H., Sevinç, C. and Kural, A.R. (2010) Primary Left Upper Quadrant (Palmer’s Point) Access for Laparoscopic Radical Prostatectomy. Urologia Journal , 7, 152-156.
Huang, K. and Lee, C. (2013) Lee-Huang Point 20 Years on. Gynecology and Minimally Invasive Therapy , 2, 103-104. https://doi.org/10.1016/j.gmit.2013.08.001
Shahrezaei, A., Sohani, M., Taherkhani, S. and Zarghami, S.Y. (2024) The Impact of Surgical Simulation and Training Technologies on General Surgery Education. BMC Medical Education , 24, Article No. 1297. https://doi.org/10.1186/s12909-024-06299-w
Hyde, G.A., Soder, B.L., Stanley, J.D., Dart, B.W., Holcombe, J.M., Cook, R.G., et al . (2018) Evaluating Surgery Resident Technical Skills: Intestinal Anastomosis in a Porcine Model. The American Surgeon™ , 84, 1801-1807. https://doi.org/10.1177/000313481808401139
Ahmed, S.K., Mohammed, R.A., Nashwan, A.J., Ibrahim, R.H., Abdalla, A.Q., Ameen, B.M., et al . (2025) Using Thematic Analysis in Qualitative Research. Journal of Medicine , Surgery , and Public Health , 6, Article ID: 100198. https://doi.org/10.1016/j.glmedi.2025.100198
Kotronoulas, G., Miguel, S., Dowling, M., Fernández-Ortega, P., Colomer-Lahiguera, S., Bağçivan, G., et al . (2023) An Overview of the Fundamentals of Data Management, Analysis, and Interpretation in Quantitative Research. Seminars in Oncology Nursing , 39, Article ID: 151398. https://doi.org/10.1016/j.soncn.2023.151398
Rhee, R., Fernandez, G., Bush, R. and Seymour, N.E. (2014) The Effects of Viewing Axis on Laparoscopic Performance: A Comparison of Non-Expert and Expert Laparoscopic Surgeons. Surgical Endoscopy , 28, 2634-2640. https://doi.org/10.1007/s00464-014-3515-9
Aust, T.R., Kayani, S.I. and Rowlands, D.J. (2010) Direct Optical Entry through Palmer’s Point: A New Technique for Those at Risk of Entry-Related Trauma at Laparoscopy. Gynecological Surgery , 7, 315-317. https://doi.org/10.1007/s10397-009-0500-8
Sankaranarayanan, G., Odlozil, C.A., Wells, K.O., Leeds, S.G., Chauhan, S., Fleshman, J.W., et al . (2020) Training with Cognitive Load Improves Performance under Similar Conditions in a Real Surgical Task. The American Journal of Surgery , 220, 620-629. https://doi.org/10.1016/j.amjsurg.2020.02.002
Brown, C., Abdelrahman, T., Patel, N., Thomas, C., Pollitt, M.J. and Lewis, W.G. (2017) Operative Learning Curve Trajectory in a Cohort of Surgical Trainees: Operative Learning Curve Trajectory. British Journal of Surgery , 104, 1405-1411. https://doi.org/10.1002/bjs.10584
Thepsuwan, J., Huang, K., Wilamarta, M., Adlan, A., Manvelyan, V. and Lee, C. (2013) Principles of Safe Abdominal Entry in Laparoscopic Gynecologic Surgery. Gynecology and Minimally Invasive Therapy , 2, 105-109. https://doi.org/10.1016/j.gmit.2013.07.003
Nishimura, R., Tanimura, S., Takemura, K., Komatsu, H., Shitano, Y., Minami, R., et al . (2018) Preventing Organ Injury during the First Punctures: Lee-Huang Point for Giant Tumors and Palmer’s Point for Umbilical Adhesion. Japanese Journal of Gynecologic and Obstetric Endoscopy , 34, 184-188. https://doi.org/10.5180/jsgoe.34.1_184
Chand, A. (2025) Challenges in Laparoscopic Camera Stabilization and How Robotics Can Solve It. Inter n ational Journal of Scientific Research in Engineering and Management , 9, 1-9. https://doi.org/10.55041/ijsrem41689
Nabeel, A., Al-Sabah, S., Al-Ghanim, K., Al-Roumi, D., Al-Basri, D., Ziyab, A., et al . (2024) Assessing and Evaluating the Impact of Operative Vision Compromise (OViC) on Surgeons’ Practice: A Qualitative Study. International Journal of Surgery , 110, 6972-6981. https://doi.org/10.1097/js9.0000000000001958