Open versus minimally invasive surgery: a man-machine system approach

Minimally invasive surgery is one of the important developments in surgery. In this type of surgery, the actual operation is performed through a number of small incisions in the skin. Special instruments are inserted via trocars, i.e. tubes that allow the surgeon to bring instruments or sensors into the body. The view at the operating field comes from a camera presenting a two-dimensional image on a monitor. The minimally invasive surgical technique has many potential benefits for the patients. However, compared to open surgery there are severe disadvantages for the surgeon, such as the loss of three-dimensional visual feedback, the disturbed eye-hand co-ordination and the poor ergonomic design of the surgical instrumentation. At this moment the differences between open and minimally invasive surgery can mainly be ascribed to differences in the manual control task. In this paper, the man-machine aspects of the traditional open operation process will be compared with those of the minimally invasive surgery process. In particular, the consequences of the restricted perception in minimally invasive surgery will be discussed. This paper focuses on minimally invasive surgery in the abdomen (laparoscopic surgery); however, most of the findings also apply to other forms of minimally invasive surgery (e.g. heart or orthopaedic surgery). Some future developments will be discussed.