Camera Navigation Training System

Abstract

This system provides training in surgical camera navigation skills. [Solution] Multiple two-dimensional targets are printed on the top surface of a flat sheet of material. The sheet is easily portable and placed on the base of a typical box training machine that defines a simulated abdominal cavity between the base and the top. A scope is inserted through a port inside the top, and the targets are viewed on a live video feed displayed to the trainee on a screen, while the targets are otherwise obscured from view by the box training machine. The trainee can move the scope back and forth, roll it, and angle the scope with respect to the port to view the targets on the sheet at different angles and distances. The trainee is instructed to follow a sequence of targets marked on the sheet and to operate the scope to sequentially align each target with the edge of the screen in a given sequence.

Description

Technical Field

[0001] [Cross - Reference to Related Applications] This application claims priority and the benefit thereof to U.S. Provisional Patent Application No. 62 / 505,011, entitled "Camera Navigation Training System", filed on May 11, 2017, which is hereby incorporated by reference in its entirety.

[0002] This application relates to surgical training, and more particularly, to devices and methods for training scope / camera navigation skills in a laparoscopic environment.

Background Art

[0003] Highly skilled surgical techniques are generally and particularly required for surgeons performing laparoscopic surgical procedures. In laparoscopic surgery, several small incisions are made in the abdomen for the insertion of trocars or small cylindrical tubes, approximately 5 to 10 millimeters in diameter, through which surgical instruments and the laparoscope are placed into the abdominal cavity. The laparoscope illuminates the surgical field, magnifies the image, and sends it from inside the body to a video monitor, providing the surgeon with a close - up view of the organs and tissues. The surgeon performs the surgery by manipulating the surgical instruments placed through the trocars while viewing the live video feed on the monitor transmitted through the laparoscope. Since the surgeon does not directly observe the organs and tissues with the naked eye, visual information is obtained by 2 - D images on the monitor instead of 3 - D observation. The loss of information when presenting a 3 - D environment through 2 - D images is significant. In particular, depth perception is reduced when viewing 2 - D images as a guide for operating instruments in 3 - D.

[0004] Furthermore, since the trocar is inserted through a small incision and placed against the abdominal wall, the manipulation of the instrument / scope is limited by the abdominal wall, which acts as a fulcrum for the instrument / scope. This fulcrum effect defines a point of angle formation that restricts the instrument / scope to limited movement. Similarly, a linear hand movement in one direction amplifies the movement of the tip in the opposite direction. Not only is the instrument / scope movement visible on the screen in the opposite direction, but the amplified tip movement depends on the proportion of the instrument / scope length above the abdominal wall. This lever effect not only amplifies the movement but also amplifies the tool tip force reflected to the user. Consequently, the operation of instruments and laparoscopes due to the fulcrum requires deliberate learning and is not intuitively obvious.

[0005] Similarly, surgical instruments and scopes are placed through ports with seals that induce stick-slip friction caused by reversal of the tool direction. For example, stick-slip friction may arise from reversal of the tool direction, for instance, when there is a rapid change from tension to compression against the tissue. During such action, the rubber components of the seal rub against the tool shaft, causing friction or movement of the instrument by the seal before the friction is overcome and the instrument moves against the seal. Stick-slip friction or oil coating at the seal and instrument / laparoscope interface generates nonlinear forces on the instrument and distracting images on the display. Such distractions can be distracting, and practice is needed to vary the insertion depth of the laparoscope to prevent them.

[0006] In particular, hand-eye coordination skills are necessary and must be practiced to correlate hand movements with tool tip movements through observation on a video monitor. Similarly, in laparoscopic surgery, tactile sensation through the tool is diminished because the surgeon cannot directly palpate the tissue with their hands. Because tactile sensation is reduced and distorted, surgeons must develop a set of primary tactile skills that form the basis of skilled laparoscopic surgery. Acquiring all of these skills is one of the main challenges in laparoscopic training, and this invention aims to improve systems and methods for laparoscopic skills training and skill performance.

[0007] Similarly, during laparoscopy, the camera operator manipulates the laparoscope. The field of view is controlled by someone other than the surgeon. In many cases, the camera operator is the least experienced individual. Medical students or interns are often entrusted with camera navigation and must quickly acquire the skills necessary to provide optimal visibility, such as recognizing and centering the surgical field, maintaining the correct horizontal axis, knowing when to zoom in or out, maintaining a stable image, and tracking moving instruments. Experienced camera operators are often those who know the case well enough to anticipate the surgeon's next move. Camera / scope navigation is critical to the proper execution of laparoscopic surgical procedures and is an important part of laparoscopic skills training. The camera operator must perform complex camera movements to follow the actions of the surgeon performing the operation and overcome the difficulties outlined above.

[0008] While the actions vary depending on the surgical procedure being performed, there is a need for simple and universal methods to train and evaluate camera navigation skills. Some studies have begun investigating the impact of inadequate camera navigation in surgical cases, anticipating that suboptimal imaging can lead to surgeon dissatisfaction and inefficiency. These studies show that the flow of surgery can be significantly disrupted when surgeons have to stop due to a lack of visibility, which could also increase the time spent in the operating room. [Prior art documents] [Patent Documents]

[0009] [Patent Document 1] U.S. Patent No. 8,764,452 [Overview of the Initiative] [Problems that the invention aims to solve]

[0010] Not only do newly appointed surgeons need to acquire laparoscopic skills, but experienced laparoscopic surgeons also strive to refine their existing skills while simultaneously learning and practicing new surgical techniques unique to newly introduced surgical procedures. While training can be achieved in the operating room, there is growing interest in devising faster and more efficient training methods, preferably outside the operating room. Surgeons who acquire a reasonable level of skill outside the operating room are better prepared when they enter the operating room, and as a result, their valuable operating room experience can be optimized, reducing patient risk and costs. Various simulators have been devised and tested to familiarize surgeons with basic surgical skills outside the operating room. An example of a surgical simulator is the SIMSEI® laparoscopic training machine, manufactured by Applied Medical Resources Corporation in California and described in U.S. Patent No. 8,764,452, which is incorporated herein by reference in its entirety. SIMSEI® is not a computer-generated virtual reality training machine, but uses a three-dimensional living organism or imitation organ or training game within a simulated abdominal cavity that is obscured from the user's direct observation. There is a need for camera navigation practice to acquire and improve camera navigation skills. Such practice tools are thought to enable trainees to acquire the skills necessary to provide surgeons with the best visibility before entering an operating room equipped with zero-degree and inclined laparoscopes. This invention provides a practice platform and system for developing the scope / camera navigation skills necessary for use in laparoscopic training environments such as laparoscopic training machines. [Means for solving the problem]

[0011] One aspect of the present invention provides a device for surgical camera navigation training. A typical surgical scope includes a sensor connected to a rectangular video display screen having a screen perimeter and a width-to-height aspect ratio. The device includes an insert having a flat top surface on which a plurality of two-dimensional targets are printed. Each target is a projection of a virtual rectangle having an aspect ratio equal to the screen aspect ratio, providing the scope with an orientation for each target with respect to a port point positioned above the insert, and that orientation brings the target to coincide with the screen perimeter. The plurality of targets have a user-indicated sequence that guides the user to achieve the orientation for each target for camera navigation training.

[0012] Another aspect of the present invention provides a system for training surgical camera navigation. The system includes a planar insert having a plurality of two-dimensional trapezoidal targets on the flat upper surface of the insert. Each target includes an associated reference marker indicating the orientation of each target relative to the insert. Sequence markers are provided on the upper surface of the insert to indicate a sequence of targets, and each target includes at least one alignment marker for aligning the target with at least one fixed reference.

[0013] Another aspect of the present invention provides a method for training surgical camera navigation. The method includes the step of providing a scope having a sensor whose longitudinal axis is perpendicular to the sensor plane. The scope is operably connected to a video screen surrounded by a rectangular frame having two opposing parallel long sides interconnected by two opposing parallel short sides, thereby defining a long-side-short side aspect ratio. The video screen is configured to display a live video feed from the scope. An insert is provided having a flat top surface defining the XY plane. The insert includes a plurality of targets in the XY plane. Each target is a projection of at least one side of a virtual rectangle positioned above the XY plane. The projection is above the XY plane and along the optical axis extending from the distal end of the scope. The scope is operated by the user to bring the projection of at least one side of the virtual rectangle to coincide with the corresponding side of the frame. [Brief explanation of the drawing]

[0014] [Figure 1] This is a top perspective view of the training machine and training system including inserts according to the present invention. [Figure 2] This is a top view of the insert according to the present invention. [Figure 3] This is a top view of the insert according to the present invention. [Figure 4] This is a top perspective view of the training system according to the present invention. [Figure 5] This is a top perspective view of the training system according to the present invention. [Figure 6] This is a top perspective view of the training system according to the present invention. [Figure 7] This is a top perspective view of the training system according to the present invention. [Figure 8] This is a top perspective view of the training system according to the present invention. [Figure 9] This is a top view of the insert according to the present invention. [Figure 10] This is a top perspective view of an insert positioned on the base of the training machine according to the present invention. [Figure 11A] Top view of the insert according to the present invention. [Figure 11B] Top view of the insert according to the present invention. [Figure 12] Top view of the insert according to the present invention. [Figure 13] Upper perspective view of the insert of FIG. 12 positioned on the base of the training machine according to the present invention. [Figure 14A] Upper perspective view of the video monitor of the training machine showing a part of the insert according to the present invention. [Figure 14B] Upper perspective view of the video monitor of the training machine displaying a target at the LOCK or HIT position for the screen display according to the present invention. [Figure 15] Upper perspective view of the insert according to the present invention. [Figure 16] Upper perspective view of the insert of FIG. 15 positioned on the base of the training machine according to the present invention. [Figure 17] Cross-sectional view of the insert having an opening according to the present invention. [Figure 18] Upper perspective view of the insert according to the present invention. [Figure 19] Upper perspective view of the insert of FIG. 18 positioned on the base of the training machine according to the present invention. [Figure 20] Schematic view of ports, targets, and origin showing insertion depth, roll angle, scope axis, polar angle, and polar radius on the polar coordinate grid of the system according to the present invention. [Figure 21] Schematic view of scope, field angle, and target point on the polar coordinate grid of the system according to the present invention. [Figure 22] Schematic view of scope and target point on the polar coordinate grid of the system according to the present invention. [Figure 23] Schematic view of scope and target point on the polar coordinate grid of the system according to the present invention. [Figure 24] Schematic view of inclined scope and target point on the polar coordinate grid of the system according to the present invention. [Figure 25A] This is a schematic top view showing the effect of roll angle on a target shape when using an inclined angle scope according to the present invention. [Figure 25B] This is a schematic top perspective view illustrating the effect of roll angle on a target shape when using an inclined angle scope according to the present invention. [Figure 26A] This is a schematic top view showing the effect of the polar radius on the target shape when using a zero-degree scope according to the present invention. [Figure 26B] This is a schematic top perspective view illustrating the effect of the polar radius on the target shape when using a zero-degree scope according to the present invention. [Figure 27A] This is a schematic top view illustrating the effect of insertion depth on the target shape when using a zero-degree scope according to the present invention. [Figure 27B] This is a schematic top perspective view illustrating the effect of insertion depth on the target shape when using a zero-degree scope according to the present invention. [Figure 28A] This is a schematic top view showing the effect of the polar angle on a target shape when using a zero-degree scope according to the present invention. [Figure 28B] This is a schematic top-view perspective diagram illustrating the effect of polar angles on target shapes when using a zero-degree scope according to the present invention. [Figure 29A] This is a schematic top view showing the effect of roll angle on a target shape using a zero-degree scope according to the present invention. [Figure 29B] This is a schematic top perspective view illustrating the effect of roll angle on a target shape when using a zero-degree scope according to the present invention. [Figure 30] This is a top view of the insert according to the present invention. [Figure 31] This is a top view of the insert according to the present invention. [Figure 32] This is a top view of the insert according to the present invention. [Figure 33] This is a top view of the insert according to the present invention. [Modes for carrying out the invention]

[0015] Moving on to Figure 1, a camera navigation training system 10 according to the present invention is shown. System 10 includes a laparoscopy training machine 12, a laparoscope 14, and an insert 16. System 10 is a training machine designed for practicing and evaluating laparoscopic camera navigation skills using a 0-degree or inclined laparoscope.

[0016] The laparoscopic training machine 12 allows trainees to practice complex surgical maneuvers in a safe and inexpensive environment. The training machine 12 is generally configured to mimic a patient's torso, particularly the abdomen. The surgical training machine 10 provides a housing that simulates a body cavity 18 substantially concealed from the user. The cavity 18 is sized and configured to accept simulated or biological tissue or model organ or training model, as well as the insert 16 of the present invention. The body cavity 18 and the surrounding insert 16 are accessed using a scope 14 through one of several access ports 20 for viewing the insert 16 positioned within the cavity 18. The surgical training machine 12 is particularly suitable for practicing laparoscopic camera navigation skills.

[0017] Continuing to refer to Figure 1, the surgical training machine 12 includes an upper cover 22 connected to and spaced apart from the base 24. Side walls can be provided to completely cover and surround the cavity 18. The base 24 includes a frame extending upward from the bottom surface within the cavity 18. The frame is configured to receive a tray (not shown) or to hold an insert 16 in place. The exemplary training machine 12 is the SIMSEI® laparoscopic training machine, manufactured by Applied Medical Resources Corporation in California and described in U.S. Patent No. 8,764,452, which is incorporated herein by reference in its entirety.

[0018] Moving to Figure 2, an exemplary insert 16 according to the present invention is shown. The insert 16 includes a flat planar top surface 26 and an opposingly positioned bottom surface 28. The insert 16 is sized and configured to be accepted into the frame of the base 24 of the training machine 12. The top surface 26 of the insert 16 includes a plurality of navigation targets 30. Although the targets 30 are shown as quadrilaterals, particularly trapezoids, the present invention is not limited thereto, and the targets can be polygonal or other shapes, as will be described in more detail below. In one variation, each target 30 has at least one straight side or line interconnected by one or more curves or lines. Each target 30 includes a marker 32 as shown in the numbers in Figure 2. Each target 30 may also include a line at the bottom of the target 30 to indicate which side of the target 30 is the bottom of the target 30 in order to reduce confusion regarding the correct orientation of the target 30. The top surface 26 may further include a passage 34 drawn on the top surface 26, if necessary. The pathway 34 includes lines and arrows to show the user a sequence of targets 30. Markers 32 can be words, letters, symbols, or pictures, as shown in Figure 3. The insert 16 in Figure 3 can be used with a set of flashcards having a corresponding set of symbols or pictures, as shown on the insert 16. The instructor can then draw one card from a set of cards, and the user will attempt to position the symbol / picture on the insert 16 using the scope by bringing the symbol / picture into the field of view on the display. The bottom surface 28 of the insert 16 can have a different pattern or arrangement of targets 30 than the pattern on the top surface 26, so that the insert 16 can be flipped over for different arrangements of targets 30. In a variation where each target 30 is a quadrilateral, each quadrilateral has a top side 40a, a bottom side 40b, a left side 40c, and a right side 40d that form a trapezoid, particularly an isosceles trapezoid. The targets 30 are configured for use with a specific scope / camera 14. Insert 16 is placed on the base 24 of the training machine 12, as shown in Figure 1.The sides of the insert 16 may include notches to help position the insert 16 in the training machine 12.

[0019] To practice laparoscopic camera navigation, the scope 14 is configured to acquire images at its distal end and display the images on a video monitor 36 having a screen display 38 that the user views as live video images are continuously acquired while the scope 14 is being manipulated. Figure 4 shows the insert 16 of Figure 2 inserted into the training machine 12 as shown in Figure 1 and laid flat on the base 24. The scope 14 is inserted into the port 20 and manipulated by hand. The display 38 shows the field of view acquired by the scope 14 at any given time. As can be seen in Figure 4, the upper end of the insert 16 of Figure 2 is shown displayed on the video monitor 36 with the first target 30a, the second target 30b, and the third target 30c visible on the display 38. The user is given the objective to bring the first target 30a followed by the second target 30b, then the third target 30c, and so on, into the field of view in sequence, as indicated by the passage 34, marker 32, or other means. In Figure 4, the sequence of targets 30 is indicated to the user by numerical markers 32a, 32b, and 32c provided on each target 30. The user's goal is not only to bring the targets 30 into view sequentially, but also, as an added difficulty, to bring each target 30 into view so that one target 30 fills the display 38 with one target 32 ​​at a time. Furthermore, the difficulty is increased by requiring the user to manipulate the scope 14 so that the top edge 40a of the target 30 is parallel to and / or coincides with the top edge of the quadrilateral / rectangle display 38, the bottom edge 40b of the quadrilateral / rectangle target 30 is parallel to and / or coincides with the bottom edge of the quadrilateral / rectangle display 38, the left edge 40c of the quadrilateral / trapezoidal target 30 is parallel to and / or coincides with the left edge of the quadrilateral / rectangle display 38, and / or the right edge 40d of the quadrilateral target is parallel to and / or coincides with the right edge of the quadrilateral display 38, in order to determine the "LOCK" position as shown in Figure 6 by filling the display 38 with the entire first target 30a.If target 30 has only one straight edge, the remaining portion of target 30 can freely have any shape, such as a curve, and success of "LOCK" will be determined by the one straight edge being parallel to and / or conforming to at least one edge of display 38. The user can pre-determine the edge of display 38 to be aligned in order to achieve an operation result suitable for achieving the training objective. Conformance may include matching and / or overlapping substantially all points of at least a portion of the perimeter, edge, or line of target 30 with at least a portion of the edges of display 38. In one variation, the perimeter, line, or entire edge is matched or overlapped with one or more edges of display 38. Figure 5 is an intermediate position where the insertion depth of the scope 14 needs to be increased to bring target 30 closer to the field of view, as shown in Figure 6. The LOCK position is easily visually assessed by the evaluator. To assist in the assessment, colored or color-contrast boundaries or lines may be provided.

[0020] The user will then move the scope 14 from the LOCK position to the next target 30. In this example, the next target 30 is the second target 30b, marked with the number 2 numeral marker 32b. The user can reduce the insertion depth of the scope 14 by pulling the scope 14 proximally to achieve a field of view on the display 38 as shown in Figure 7, where the first target 30a and the second target 30b are within the frame defined by the display 38. The dotted arrow of the sequence path 34 is also visible between the two targets 30a and 30b. Due to the limited field of view of the camera, only a portion of the path 34 is visible at any given time, so the path 34 helps the user in hinting at the direction of the next target 30b. The user moves the scope 14 to bring the second target 30b to the LOCK position as described above. Figure 8 shows that the second target 30b is slightly angled at its upper end relative to the top edge 40a, left edge 40c, and right edge 40d. The user is prompted by the training machine to operate the scope 14 to bring the second target 30b to a more complete LOCK position, or the evaluator may deduct points due to insufficient accuracy. The user will continue to search for each target 30 according to the sequence shown to the user using the markers 32 and / or passages 34. As shown in Figures 6 to 8, when moving from the first target 30a to the second target 30b, the user may have to rotate the scope 14 around its longitudinal axis and change the angle of the shaft of the scope 14 relative to the insertion port 20 of the upper cover 22. Thus, the two actions, namely rotating and angling, are encoded within the arrangement of the first and second targets 30a, 30b relative to each other, which is advantageous as it allows the system to teach a specific set of actions applicable to a particular surgical procedure, or a combination of actions encountered in surgery, or a combination of actions of varying difficulty for training purposes, or simply a specific combination of actions. One or more combinations of actions are encoded not only between two adjacent targets 30, but also across multiple targets 30 or across all targets 30 on the insert 16.

[0021] For example, referring particularly to Figures 9 to 11, an insert 16 according to the present invention is shown with an arrangement of multiple targets 30 printed on its top surface 26. In this variation, each target 20 has at least two parallel opposing sides and two opposing sides that are angled with respect to the other two sides. The insert 16 is shown in Figure 10 in a state where it is placed flat on the base 24 of the training machine 12. The flat insert 16 may include contours and notches 42 so that its perimeter interfaces with features found on the base 24 of the training machine 12, as can be seen in Figure 10. The notches 42 and size of the insert 16 are such that they closely conform to the shape of the base 24 or the frame of the base 24, so that there is little to no room for the insert 16 to move relative to the base 24. There is a single orientation of the insert 16 based on the notches 42 that allows the insert 16 to sit flat on the base 24 of the training machine 12, in which position there is no room for the insert 16 to slide forward / backward or side to side. The fact that the target 30 is in a specific position relative to a specific port 20 into which the scope 14 is inserted into the training machine 12 is important to the function of the insert 16 with respect to the training machine 12. Because the shape of the target 30 is set with respect to a specific port position relative to the training machine and the insert, the scope 14 cannot be removed and inserted into a different port 20 on the training machine 12, and the same insert 12 cannot be continued as a camera navigation training machine. Essentially, each insert 20 is individualized with respect to the position and distance of the insertion port 20 on the training machine used so that the visual shape remains correct when aligning the target on the display 38. If the insert 16 is not in the correct position within the base 24 of the training machine or if the wrong scope port 20 is used, the target 30 will not align with the side of the display 38 as intended with respect to the LOCK position.

[0022] Figure 11A shows a first exemplary sequence of targets 30 defined by markers 32 and a first pathway 34 represented by a series of interconnected arrows. Figure 11B shows a second sequence of targets defined by a second pathway 34 represented by a series of arrows. The targets 30 are the same size and shape and are in the same position in Figures 11A and 11B, but by changing the sequence in which the user moves within the range indicated by numbered markers 32 from 1 to 11, the pathway 34 that the user follows as the target pathway 34 of the training machine can be designed to be more difficult or easier, or to specifically train the user in a particular type of camera operation. Each movement between targets 30 can be designed with a specific intention. For example, a movement from one target to another may require only modifications to the camera insertion depth or one of the other parameters described below, or a movement between targets may require modifications to some or all of the camera position parameters. For example, in the first sequence shown in Figure 11A, the movement from target 6 to target 7 requires rotating the scope 14 around its longitudinal axis to increase the insertion depth, whereas the movement from target 6 to target 7 in Figure 11B requires changing the polar angle. The size and position of the target, combined with the sequence assigned to target 30, define a specific working path. Targets 30 can be designed to compel the user to move the camera in a specific way that correlates with camera movement for a particular surgical procedure or a particular difficulty level. Sequences do not need to be defined as being located within numerically represented organs; random sequence numbers can be called out to surprise the user and add an extra dimension of training to the practice.

[0023] Moving from Figure 12 to 14, another insert 16 according to the present invention is shown, with an arrangement of multiple targets 30 printed on its top surface 26. In this variation, there are no number / letter-like markers 32 to indicate the passage 34 or sequence of targets 30 to follow. However, the insert 16 includes a transparent, replaceable layer with a numbered passage sequence, or a non-removable laminate layer attached to the top surface 26, allowing markers 32 to be written on the insert 16 or markers for a whiteboard to be used to indicate the passage 34. The passage 34 can be marked to simulate specific surgical procedures. Figure 13 shows the insert from Figure 12 positioned within the cavity 18 of the training machine 12. Figure 14A shows a video monitor 36 showing a field of view captured by the scope 14 so that the display 38 includes some of the multiple targets 30 on the insert 16 from Figure 12. Figure 14B shows the LOCK position, where one target 30 is fitted within the frame of the display 38 so that the edges of the target 30 substantially match and are parallel to the edges of the display 38. All 2D target shapes printed on insert 30 appear as rectangles and conform to the rectangular shape on the screen when the scope is in the encoded position relative to the insert / trainer. The shape of target 30 is trapezoidal, not rectangular, on the insert and on the screen until the LOCK position is achieved.

[0024] Moving on to Figures 15 through 17, another variation of the insert 16 according to the present invention is shown. The insert 16 is a combination of two inserts 16a, 16b stacked on top of each other. The insert 16 includes a first layer 16a of pre-printed targets 30 stacked spaced apart on a second layer 16b of pre-printed targets 30. The first insert 16a is positioned at a distance above the second insert 16b. The insert 16a includes at least one opening 44 that provides access to the second insert 16b below. The at least one opening 44 is sized and configured such that a scope can pass through the first insert 16a to observe the targets 30 provided on the second insert 16b. The first insert 16a advantageously obscures the targets 30 on the second insert 16b, thereby increasing the difficulty of performing camera navigation practice. Furthermore, as depicted in Figures 15 to 17 and applicable to all variations described herein, each target 30 includes an outer boundary 30a defining a first target 30a and an inner boundary 30b defining a second target 30b. Thus, the insert 16 generates a LOCK position relative to the inner boundary 30b and / or outer boundary 30a, thereby providing the user with additional practice variations to practice insertion depth control advantageously. Also, Figures 15 to 17 show two targets 30 of different colors, such as a lighter yellow and a darker blue. The colors can be inside the inner boundary 30b, the outer boundary 30a, the inner boundary 30b, or outside the outer boundary 30b. The goal in a single instruction can be to obtain a LOCK position for all targets 30 of the same color, or to alternate between targets of different colors. The color contrast between the first target 30a and the second target 30b also facilitates the determination of the LOCK position for the evaluator. As can be seen in Figures 15 to 17, the overlapping targets 30 are clearly visible as a result of using different colors. More targets 30 can be mounted on the insert 16 in an overlapping manner.

[0025] Moving from Figures 18 to 19, another variation of the insert 16 according to the present invention is shown. In this variation, the insert 16 includes a base 46 supporting a plurality of targets printed on at least one face of a three-dimensional shape 48. While the shape 48 is a box, the present invention is not limited thereto, and the shape 48 can have any suitable shape in which at least one of the shape faces is planar and / or quadrilateral. The shape / box 48 is angled relative to the base 46, and in particular, the quadrilateral / rectangular face is inclined relative to the base 46 to achieve spatial positioning desirable for positioning and training the scope operator. As described above, the scope operator will operate the scope 14 to align the rectangular target 30 seen on the display with the display frame to achieve the LOCK position. One or more boxes 48 may include an opening 44 that is sized and configured such that the scope 14 can pass through and see at least one additional target 30c printed inside the box 48. The outside of the box 48 can be provided with concentric targets 30a and 30b, the first target 30a being defined by the outer boundary and the second target 30b being defined by the inner boundary. Concentric targets can also be provided on the inner surface of the box 48. The targets may include color as described above. The dimensions of the targets are designed to match the aspect ratio of the camera image seen on the training machine screen. Thus, when the scope is pointed into the box, inserted to the correct depth, and the roll angle of the laparoscope is correct, the colored boundary of the box will be aligned with the edge of the training machine display. To further achieve training regarding camera depth correction, one or more openings 44 can be provided in one or more boxes 48. Although the figures show the openings 44 on the same side as the outer target 30 and the box 48, the present invention is not limited in this way, and the openings can be provided on any side of the three-dimensional shape. One or more internal targets 30c accessible through the openings 44 are provided. The internal target 30c can be positioned to prompt the user to adjust the camera's roll angle and insertion depth relative to one or more targets 30a, 30c located outside the box 48.This configuration guides the user to adjust the camera's insertion depth, in addition to the camera's roll angle, to bring the internal target 30c to the correct LOCK position / orientation. Furthermore, the internal target 30c can be designed to work with an inclined scope, in which case the internal target 30c can be mounted on the side walls of the box as well as simply on the rear / bottom walls. By assigning a specific numbered sequence to the target 30, a specific operating path is defined for the user. The difficulty is increased by the internal target, which requires scope operation within the box's area. Evaluation can be automated by, for example, detecting the alignment quality of the target and providing feedback to the user, such as by illuminating the display frame in a significant color.

[0026] Each target 30 corresponds to a unique camera position determined by four variables. The four variables determining the camera position include (1) insertion depth, (2) roll angle, (3) polar radius, and (4) polar angle. Furthermore, multiple targets are placed in a sequence of consecutive targets, and this sequence is marked with letters or numbers. By providing an insert with an arrangement or set of multiple targets based on the four variables described above, and assigning a specific sequence to the generated targets, a unique and distinctive motion path is created for the user to navigate with the scope camera. This motion path can be designed to mimic clinically associated camera movements of varying complexity and difficulty. The training device can be tailored to a specific skill level in general practice and to a specific surgical procedure in more specific practice.

[0027] The camera navigation skills training insert of the present invention is an effective tool for teaching newly appointed surgeons how to navigate a laparoscope or other camera inside a patient's body. Users can practice moving the camera and positioning targets in the monitor's field of view in a manner that allows for objective evaluation of the precise sequence of targets and the speed at which designated targets are completed sequentially, along with the accurate positioning of each target. The camera navigation skills platform is a simple, passive practice that allows users to practice camera navigation skills without computer simulation and can be used by instructors to easily and quickly evaluate the user's progress and proficiency. For example, proficiency is demonstrated if the user can successfully navigate between a series of targets within a given time limit.

[0028] The insert encodes a specific set of camera movements into a visual two-dimensional medium. Each target incorporates four defining variables of the camera position (insertion depth, roll angle, polar radius, and polar angle), so there is one unique set of these variables that aligns the target boundary with the edge of the training screen. A specific set of targets is then defined so that the movement from each particular target to the next incorporates desirable movements that have clinical training or educational validity. Alignment of the target edges with the edge of the training screen provides the instructor with a clear visual indication that a specific camera orientation has been reached. This practice is considered passive because there is no active electronic evaluation system / software, computer simulation, or virtual reality to demonstrate successful scope placement.

[0029] This method provides a laparoscopic training machine 12 having a video monitor 36 connected to a laparoscope 14. The laparoscope 14 is directed towards an insert 16 provided in a cavity 18 of the training machine 12. At least a portion of the image of the insert 16 is captured by the laparoscope 14 and displayed on the video monitor 36. The insert 16 includes a plurality of targets 30 placed on the insert 16, which are visible in the image on the video display 38. Positioning the laparoscope in the three-dimensional space of the cavity relative to the insert 16 will generate a specific image on the video display 38. As the laparoscope 14 is moved in the three-dimensional space of the cavity 18, the two-dimensional image changes. The user selects one of the plurality of targets 30 and moves the laparoscope 14 in the three-dimensional space of the cavity 18 until the selected target 30 appears to fill the video display, aligning the area around the selected target 30 with one or more markers connected to the video monitor 36. The marker can be the perimeter / frame of the display 38 of the video monitor 36, or at least one edge of the perimeter / frame of the display screen. The positioning of the laparoscope 14 is such that the selected target 30 aligns with one or more markers / perimeters / frames. In particular, at least one edge of the target 30 is aligned with at least one edge of the marker, or all of the edges of the target 30 are aligned with all of the edges of the markers / perimeter / frame.

[0030] Insert 16 guides the user through a specific series of actions using the camera, using a sequence of targets 30, to train camera navigation skills. The camera is inserted through port 20 on the laparoscopy training machine 12, and the targets 30 are positioned on top of the insert 16 which fits inside the training machine 12.

[0031] In one variation, the target 30 is a quadrilateral / trapezoid that is perfectly aligned with the edge of the training machine's screen when viewed from the correct orientation with a laparoscope. The movement from one target to another may include one or more of the following: correction of the insertion depth of the laparoscopic camera, correction of the polar angle, correction of the polar radius, and correction of the roll angle.

[0032] In one variation, one or more targets 30 are provided on a flat substrate material. One or more targets 30 are printed or bonded onto the substrate. In other variations, the substrate includes multiple faces that are positioned / angled relative to each other, as shown in Figures 15 to 19. Complexity can be increased by modifying the shape of the substrate to include more faces or by including cavities that require the user to look around corners or faces using a standard zero-degree scope or inclined scope.

[0033] In one variation, the motion path is predetermined by the sequential layout of targets on the substrate. A specific sequence is communicated to the user by placing numbers, symbols, letters, etc., on the targets, using colors, or by connecting the targets with lines drawn on the inserts. During practice, the user is required to follow the predetermined motion path in order to successfully complete the practice. Multiple positions are selected along the desired motion path, and a unique target is provided at each position. A unique target is constructed for each position along the motion path. In this case, the sequential motion through the targets represents the original design intent regarding the conceptual motion path for a specific clinical / educational goal or outcome.

[0034] The user can explicitly design the target-to-target movement paths by generating and positioning targets 30 in a manner that requires a specific camera orientation so that the target boundary aligns with at least one edge of the training screen. Since targets 30 are defined by four parameters that can also be used to explicitly define a specific camera orientation, movement from one target to another explicitly defines a specific movement path relative to the camera. These movements can include variations on any of the four variables and / or combinations of the four defining variables for camera orientation. In other words, each target represents a concrete example of a fully defined unique camera orientation. In this case, the movement path can be fully defined by a fully defined set of camera orientations encoded in a series of corresponding targets.

[0035] A successful camera navigation event, known as a HIT (Hit), is defined by a visual indication that the target boundary is aligned with the edge of the screen. Time elapses until the user achieves a HIT and it becomes possible to measure and score it for evaluation purposes. The visual HIT provides the instructor with a basis for evaluating the user's progress and skill. The HIT also provides the user with a defined navigation goal. Prior to this invention, there were no objective evaluation markers for camera navigation skill training. Individuals could navigate the camera in a "free style" using organ models, living patients, cadavers, etc., but there was no objective way to measure and evaluate camera navigation skills. In contrast, when used for evaluation, this invention relies on the instructor's judgment to determine when the target boundary is properly aligned with the edge of the screen. Skill inserts and practice according to the present invention are designed to facilitate objective evaluation of various learning requirements of camera navigation, including functions to maintain or adjust camera orientation, appropriate insertion depth, and sequential navigation.

[0036] Moving on to Figure 20, a schematic diagram of the four input variables is shown. Figure 20 shows the four variables used in the camera navigation practice of the present invention to determine a specific camera orientation: insertion depth, roll angle, polar radius, and polar angle, in addition to the port point 52 into which the laparoscope is inserted and the target point 50 on the insert 16. The target 30 is constructed based on this geometric arrangement. The target point 50 can be any point on the planar insert 16, or it can be a clinically associated point having anatomical / surgical importance. Organs can be depicted on the planar insert, and a particular target point 50 may correspond to the location of, for example, the liver. The target point 50 in the figure is the center of the final target 30 drawn on the insert 16. The origin 54 of the polar coordinate system used for the polar angle and polar radius is also shown. The same origin 54 can be used when adopting Cartesian coordinates. The origin 54 is typically located on the plane 58 of the insert 16. In one variation, the origin 54 is located just below the port point 52.

[0037] Moving to Figure 21, we see a laparoscope 14 inserted at port point 52. The laparoscope 14 includes a longitudinal scope axis 56. Port point 52 is fixed to an insert positioned below port point 52, giving the laparoscope four degrees of freedom of movement. In particular, when the insert 16 defines the XY plane with the Z axis perpendicular, the laparoscope 14 has a rotational envelope plane that includes tilting left and right on the X axis and tilting forward and backward on the Y axis, defining a conical working space with two degrees of freedom of movement where port point 52 acts as a fulcrum. The third movement is the vertical translation of the scope along the Z axis, given by translating the scope along its longitudinal axis through the insertion / port point 52. The fourth degree of freedom of movement is the rotation of the scope around the longitudinal axis, such as rotating the scope left and right on the Z axis. Since the port point is fixed, the laparoscope is limited to lateral movement around the X axis and forward and backward movement around the Y axis. In other words, port point 52 does not move, and therefore the scope at the pivot point does not move.

[0038] In Figure 21, the laparoscope 14 is pointed toward the target point 50 such that the target point 50 lies on the scope axis 56. The field of view is depicted as a cone 60. The final target 30 printed on the insert 16 is a two-dimensional representation of a specific laparoscopic camera orientation when the target point 50 is on the scope axis 56. The specific laparoscopic camera orientation corresponds to a virtual target point 62 located in a plane 64 perpendicular to the scope axis 56, as seen in Figures 21 to 23. The virtual target point 62 can correspond to a point on a virtual object above the insert plane 58. For example, the virtual object could be the gallbladder, with the virtual target point 62 being the center of the gallbladder, and the plane 64 perpendicular to the scope axis 56 being the optimal observation plane from a surgical perspective. The insertion depth is determined by moving the scope 14 along the scope axis 56. In some cases, the camera operator may need to pull the scope 14 proximal so that the distal end of the scope captures a larger field of view for exploration or space for instruments. Therefore, the target point 50 and insertion depth are determined for clinical purposes or to provide variety in training practice. The virtual planar shape 64 has a predetermined perimeter 66 or boundary 66 corresponding to the aspect ratio of the camera sensor. The aspect ratio of the camera may be the same as the aspect ratio of the video monitor 36, but may not be. If the aspect ratio is different, the aspect ratio of the monitor 36 is used to determine the boundary / perimeter 66. The plane 64 perpendicular to the scope axis 56, in particular the boundary / boundary 66 of the planar shape 64 perpendicular to the scope axis 56, has a projection onto the insert plane 58. As seen in Figure 23, it is this projection that defines the target 30 printed on the insert plane 58. The projection forming the target 30 has a slanted perimeter on the insert 16, which will have a perimeter that is vertical and fits the screen when viewed in the LOCK position described above. The target point that fits the origin will have a target 30 with a line perpendicular to the insert. In one variation, the insert plane 58 is a horizontal plane corresponding to the base 24 of the training machine 12. The insert plane 58 can also be defined as a plane perpendicular to the line containing the port point 52 and the origin 54.In this case, all of the targets 30 of a particular insert are combined into a single image, which is printed at a fixed scale and placed in the training machine with one specific, fully defined camera orientation in which each target has its target boundary aligned with the outer edge of the screen, as described above. Different inserts 16 can be calculated, generated / printed for use with different insertion ports 20 and port points 52. Similarly, the insert 16 can be modified to utilize other laparoscopic cameras and scopes by reconfiguring the target design based on the aspect ratio of the camera / monitor.

[0039] Figures 21 to 23 show a zero-degree scope 14, and Figure 24 shows a schematic diagram of an inclined scope 68. The process and calculation for generating targets for the inclined scope are the same as described above, except that the inclined axis 70 is used instead of the longitudinal axis 56 of the scope as in the zero-degree scope 14. The inclined axis 70 is perpendicular to the lens plane of the inclined scope 68. The same four input variables completely determine the geometric arrangement of the targets. However, as seen in Figure 25, when using an inclined scope, the roll angle has a greater influence on the target shape. Figure 25 shows the greater influence of the roll angle on the target shape when using an inclined scope with respect to the top edge 40. The insert 16 having an opening 44 that provides access to a second level target 30c is particularly suitable for use with an inclined scope because its targets mimic conditions often encountered during surgical procedures where the camera operator needs to use an inclined scope to visualize anatomical structures that cannot be seen using a zero-degree scope. Thus, the present invention also provides an effective practice platform for practicing camera navigation with an inclined scope in challenging anatomical situations.

[0040] Figure 26 shows the difference between targets 30 having constant insertion depth, roll angle, and polar angle, but different polar radii. For this reason, these targets 30 guide the user to correct only the polar radius of the scope 14, as shown in the figure.

[0041] Figure 27 shows the difference between targets 30 having constant polar radius, roll angle, and polar angle, but different insertion depths. For this reason, these targets 30 guide the user to only modify the insertion depth of the scope 14 from stage 1 to 3, as shown in the figure.

[0042] Figure 28 shows the difference between targets 30 having different polar angles while maintaining constant insertion depth, roll angle, and polar radius. For this reason, these targets 30 guide the user to only correct the polar angle of the scope 14 from stages 1 to 3, as shown in the figure.

[0043] Figure 29 shows the difference between targets 30 having constant insertion depth, polar radius, and polar angle, but different roll angles. For this reason, these targets 30 guide the user to only modify the roll angle of the scope 14, as shown in the figure.

[0044] Moving from Figure 30 to 32, another variation of the insert 16 according to the present invention is shown. The insert 16 includes a flat planar top surface 26 and an opposingly positioned bottom surface 28. The insert 16 is sized and configured to be accepted into the frame of the base 24 of the training machine 12. The top surface 26 of the insert 16 includes a plurality of navigation targets 30. The targets 30 are shown to be quadrilaterals, particularly trapezoids, particularly isosceles trapezoids, but the present invention is not limited thereto, and the targets can be other shapes such as polygons, circles, etc. For example, each target 30 has at least one straight side or line interconnected by one or more curves or lines.

[0045] Each target 30 includes a sequence marker 32, such as a number. The sequence marker 32 indicates the order in which the targets 30 should be placed in the camera's field of view for display and alignment. Taken together, the sequence of targets displayed by the sequence marker 32, combined with the size, shape, and orientation of each target 30, can have clinical significance in addition to training significance. For example, the changing size of each target 30 can help the user train their camera zoom-in / out skills, while a sequence of multiple targets 30 may represent a pathway defined in a particular surgical procedure.

[0046] Each target 30 may also include additional orientation markers. In Figures 30 to 32, the numbers 32 positioned inside the target 30 function both as a sequence indicator between multiple targets 30 and as orientation markers for each individual target 30. The orientation markers indicate to the user how to orient the target 30 relative to the screen display. For example, the user is asked to orient the numbers in the correct up-and-down order so that the numbers are not upside down and are easy to read. Another example of an orientation marker is a line of a specific significant thickness positioned at the bottom of the target 30 to indicate which side of the target 30 is the bottom of the target 30, for example, to align with the bottom of the display, in order to reduce confusion regarding the correct orientation of the target 30. The orientation markers indicate the orientation the user should take when focusing on each target.

[0047] The top surface 26 may further include directional markers 34, also called path markers 34, as needed. An example of a directional marker 34a is a line and arrow drawn on the top surface 26. The line and arrow are positioned between two adjacent targets 30. As the user zooms out in the camera field of view, the base of the arrow becomes visible to the user, at which point the user knows to follow the arrow to the next target 30 in the sequence. Secondary directional markers 34b may also be provided to the user. An example of a secondary directional marker 34b is a recess or discontinuity at the edge boundary of a target 30. The recess or discontinuity is in the shape of an arrow and appears as an extension extending away from the target or as a recess in the shape of an arrow into the target 30. The secondary directional marker 34b gives the user the direction in which to move the camera after aligning the target 30 with the display frame. The secondary directional marker 34b provides the user with sequence direction information without zooming out too much with the camera, as is the case when the directional marker has an arrow positioned between two adjacent targets 30. The path / directional marker 34 also indicates the sequence of targets 30 to the user. The dotted line on the directional marker 34 also guides the direction of rotation. The orientation marker 32 can also be a word, letter, symbol, or picture that the user will know how to orient it in the correct up-down relationship within the display frame. The sequence of targets 30 can be determined using an ordered or random set of flashcards having corresponding sets of symbols, words, or pictures as shown on the targets 30. The instructor can draw cards from a set of cards, and the user will then attempt to find the symbols / pictures on the insert 16 in scope by bringing the symbols / pictures into view in the display. In one variation, the symbols / pictures on the targets 30 relate to anatomical structures with respect to their relative positions on the insert.

[0048] As described above, the user aligns one or more of the periphery with one or more of the periphery of the display monitor frame. In the variations shown in Figures 30 to 32, the insert 16 includes alignment markers 78 in addition to the periphery / boundary of the target polygon. The alignment markers 78 include one or more brackets, lines, or combinations of lines provided at a distance inward from the outer edge / periphery of the target. In particular, the brackets in Figures 30 to 32 have two intersecting lines to form a corner for alignment with one of the corners of the rectangular display screen. In the variations shown in Figures 30 to 32, the alignment markers 78 include four brackets, each having one corner for alignment with the four corners of the display screen. Secondary alignment markers 78 are added to the alignment markers defined by the periphery / boundary of the target 30. This arrangement allows the user to align at least one boundary / perimeter of the target with the perimeter of the display screen, or at least one bracket with at least one corner of the display screen, or at least one bracket with the space between the corresponding corner of the boundary / perimeter. Since insert 16 is intended to accommodate various users with varying levels of skill and dexterity, the combination of primary and secondary alignment markers advantageously establishes an acceptable margin of error for each skill level. For example, a novice user would be instructed to align the target boundary / perimeter with the display frame. A more skilled user would be instructed to align the bracket with the display frame. Since the brackets are not interconnected, the user's eyes must travel longer distances or exercise peripheral vision and enhanced perception for rapid and accurate camera navigation. After first aligning the boundary / perimeter, the user can be given a two-step command to zoom in, which is relatively difficult, to align the bracket with the display screen. In the variations shown in Figures 30 to 32, the user attempts to align all four brackets 78 with all four corners of the display screen.

[0049] The bottom surface 28 of the insert 16 can be provided with a different pattern or arrangement of targets 30 than the pattern on the top surface 26, so that the insert 16 can be flipped over for different arrangements of targets 30. In other modifications, the bottom surface 28 of the insert 16 contains instructions for setting up and training using the insert 16. In a variation where each target 30 is a quadrilateral / trapezoid, each quadrilateral / trapezoid has a top side 40a, a bottom side 40b, a left side 40c, and a right side 40d. The targets 30 are configured for use with a specific scope / camera 14. The insert 16 is placed on the base 24 of the training machine 12 as shown in Figure 1. The sides of the insert 16 may include notches 42 to help position the insert 16 on the training machine 12. After the insert 16 is positioned on the base 24 of the training machine 12, the user is instructed to position the laparoscope camera at the central port of the training machine. The size and shape of the targets 30 are based on a fixed camera port point 52. The user is instructed to start with target number 1 and use the training machine's camera / scope to align the corners of each of the 30 target brackets with the outer edge of the screen, proceeding in order to the end. The brackets can be color-coded to make the practice more difficult or easier depending on the color contrast. For example, lighter colored brackets are easier to align than brackets with less color contrast against the background.

[0050] Referring particularly to Figure 30, the configuration of the target 30 on insert 16 is roughly based on a cholecystectomy. This arrangement focuses on zooming in and out using multiple targets 30 dedicated to this operation. The design also guides the user to curl the camera approximately 180 degrees by including a target 30 at a 90-degree angle.

[0051] Referring particularly to Figure 31, the configuration of the target 30 on insert 16 is roughly based on a right colectomy in which the right colon is removed. This placement is difficult because these targets require the user to curl the camera and maintain a stable image at an unnatural angle, and the focus is on teaching camera rotation around various axes rather than zooming in and out.

[0052] Referring particularly to Figure 32, the configuration of the target 30 on the insert 16 is broadly based on a vaginal hysterectomy. This configuration focuses on various types of camera movement.

[0053] Moving on to Figure 33, another variation of the insert 16 according to the present invention is shown. The insert 16 includes a plurality of targets 30, each target having an alignment marker 78 having a single straight line. This line has length, width, and thickness. The length of the line corresponds to the aspect ratio of the camera, such that when the line aligns with one of the sides of the display screen, a HIT or LOCK is achieved when the length of the line is between two parallel adjacent sides of the display screen. The user aligns the two endpoints of the line with two corners, such as the two corners at the bottom of the screen. Sequence markers 32 are given in the form of numbers, which also function as orientation markers that indicate to the user to orient the numbers in the correct up-down relationship. The lines 78 are interconnected by curved shapes, as in the case of targets 1 and 10. For the remaining targets 30, the lines 78 intersect and are surrounded by curved shapes. The shapes are colored and can generally function as orientation markers, with the majority of the shape positioned within the display screen when the lines 78 are aligned. In one variation, target 30 has only line 78 in combination with a command to align line 78 with one of the four edges of the display screen. For example, the command would cause the user to align the entire line 78 of target 30 with the bottom edge of the display screen. Alternatively, the specific edge of the screen to be aligned with line 78 can be indicated on the target itself. If necessary, each target 30 may be provided with a sequence marker and / or an orientation marker and / or directional marker. The line thickness is approximately 0.06 inches, or 0.04 to 0.08 inches, or 0.03 to 0.12 inches. This value gives the user a small range of insertion depth and angle to position the camera so that the line is still visible at the bottom of the screen. If the line thickness is too large or too large, the practice will be overly simplified, and if the line thickness is too small, the practice will be too difficult. Of course, the line may be larger or smaller than the given range and is within the scope of the present invention. The edges of the lines are parallel to the azimuth lines for each target, so they will align with the bottom edge of the screen. Of course, any of the exercises can include a duration command to hold any one of the targets in the align LOCK or HIT position.

[0054] The design, shape, placement, and sequence of the targets 30 on the insert 16 encode various learning requirements that have been identified as crucial for the development of proficiency in camera navigation. The geometric arrangement of the shapes for camera navigation practice, considering polar coordinates, insertion depth, and roll, facilitates the assessment of camera navigation skills. Users have a defined objective, "fill the screen," and can perform this task while improving their proficiency through planned practice. The structure of the insert and practice associated with the targets is advantageous in that it generates a consistent, standardized, objective assessment for all learners, in contrast to varying degrees of feedback on skill levels from multiple surgeons / evaluators. This system allows for the practice of basic camera navigation skills such as hand-eye coordination, visuospatial awareness, and dexterity in a non-virtual environment without the use of computer simulations, video projections, etc. The evaluator is advantageous in that it provides a way to objectively assess the user's success, as well as consistency across the entire assessment and between different evaluators. Since alignment in HIT or LOCK positioning is extremely precise, perhaps even more so than necessary, the system of the present invention advantageously compels learners to be more precise. For example, as shown in Figures 15 to 19, aligning the screen to the inner target 30b or the outer target 30a, or to a position between the inner target 30b and the outer target 30a, requires greater precision than simply bringing the target point 50 into the field of view on the screen, as in any other camera navigation training system that uses, for example, model organs. The system of the present invention provides a method for evaluating camera navigation skills. Skill development can be encoded as sequential target progress for each insert, as well as across sets of inserts of progressively more difficult or different skill levels or encoded skills. Furthermore, the system is reusable and easily portable.

[0055] It will be understood that various modifications are possible to the embodiments disclosed herein. Therefore, the above description should not be interpreted as limiting, but rather as merely illustrative of preferred embodiments. Those skilled in the art will be able to envision other modifications within the scope and spirit of the disclosure of the present invention. [Explanation of Symbols]

[0056] 10 Camera Navigation Training System 12 Laparoscopic training machine 14 Laparoscopy 16 Inserts 20 insertion ports

Claims

1. A device for training surgical camera navigation, using a surgical scope having a sensor and a longitudinal axis, and operably connected to a rectangular video display screen having a screen perimeter and a width-to-height aspect ratio, An insert with a flat top surface, The plurality of two-dimensional targets on the upper surface, each target being a projection of a virtual rectangle having an aspect ratio equal to the aspect ratio of the screen, the scope having an orientation for each target with respect to a port point positioned above the insert, the orientation aligning the target with the periphery of the screen, and the plurality of targets having a sequence that guides the user so that the plurality of targets achieve the orientation for each target for camera navigation training, A device characterized by including

2. A system for training in surgical camera navigation, A planar insert having a plurality of two-dimensional trapezoidal targets on a flat upper surface of the insert, wherein each target includes an associated reference marker indicating the orientation of each target relative to the insert, and sequence markers on the upper surface of the insert indicate a sequence of targets, and each target includes at least one alignment marker for aligning the target with at least one fixed reference, A system characterized by including

3. A method for training surgical camera navigation, A step of providing a scope having a sensor and a longitudinal axis perpendicular to the sensor plane, wherein the scope is operably connected to a video screen surrounded by a rectangular frame having two opposing parallel long sides interconnected by two opposing parallel short sides that define the aspect ratio of the long side to the short side, and the video screen is configured to display a live video feed from the scope. A step of providing an insert having a flat upper surface that defines an X-Y plane, wherein the insert has a plurality of targets in the X-Y plane, each target being a projection of at least one side of a virtual rectangle positioned above the X-Y plane, the projection being onto the X-Y plane and along the optical axis of the scope extending from the distal end of the scope, A step of manipulating the scope so that the projection of at least one side of the virtual rectangle coincides with the corresponding side of the frame, A method characterized by including the following.

4. The device according to any one of claims 1 to 3, characterized in that the plurality of targets are printed on the upper surface.

5. The device according to any one of claims 1 to 4, characterized in that the target has a trapezoidal shape.

6. The device according to any one of claims 1 to 5, characterized in that the projection of the virtual rectangle is the projection of a straight line corresponding to at least one side of the virtual rectangle.

7. The device according to any one of claims 1 to 6, characterized in that the longitudinal axis is perpendicular to the sensor.

8. The device according to any one of claims 1 to 7, characterized in that the projection of the virtual rectangle is along the longitudinal axis.

9. The device according to any one of claims 1 to 8, characterized in that the flat upper surface interfaces with a parallel flat lower surface to define a planar insert.

10. The device according to any one of claims 1 to 9, characterized in that each target includes a second projection of the virtual rectangle that shares the same center as the first projection.

11. The device according to any one of claims 1 to 10, characterized in that the second projection is a projection of only the corners of the second virtual rectangle.

12. The device according to any one of claims 1 to 11, characterized in that the second virtual rectangle is smaller than the first virtual rectangle.

13. The system according to any one of claims 1 to 12, further comprising a camera scope configured to display a live video feed from a camera scope and operably connected to a screen having a width-to-height aspect ratio.

14. The system according to any one of claims 1 to 13, characterized in that each target is a projection of a virtual rectangle positioned above the insert, the projection being onto the upper surface and along an optical axis extending parallel to the plane of the distal end of the scope.

15. The system according to any one of claims 1 to 14, characterized in that the alignment marker is at least a portion of the periphery of the screen, and the virtual rectangle has an aspect ratio equal to the aspect ratio of the screen.

16. The system according to any one of claims 1 to 15, characterized in that the optical axis is perpendicular to the sensor of the scope.

17. The system according to any one of claims 1 to 16, characterized in that the optical axis is inclined with respect to the longitudinal axis which is perpendicular to the sensor of the scope.

18. The system according to any one of claims 1 to 17, characterized in that each target is a projection of at least a portion of a virtual rectangle positioned above the insert, the projection being onto the upper surface and along an optical axis extending from the distal end of the scope.

19. The system according to any one of claims 1 to 18, further comprising a direction marker that provides direction information to the next target in the sequence.

20. The system according to any one of claims 1 to 19, characterized in that the direction marker is an arrow or a discontinuity around the target.

21. The system according to any one of claims 1 to 20, characterized in that a reference marker is selected from a group consisting of numbers, letters, images, lines parallel to and coinciding with or adjacent to the bottom of the target, lines parallel to and coinciding with or adjacent to the top of the target, lines parallel to and coinciding with or adjacent to the right side of the target, and lines parallel to and coinciding with or adjacent to the left side of the target.

22. A planar base that is sized to accept the insert and configured to accept the insert, The upper part, spaced apart from the base, has a cavity between the upper part and the base, and has a port for inserting the scope, The system according to any one of claims 1 to 21, further comprising a box training machine including a box training machine.

23. The system according to any one of claims 1 to 22, characterized in that an alignment marker is selected from a group consisting of brackets, the outer circumference of the target, the inner circumference of the target, a boundary, and a line.

24. The system according to any one of claims 1 to 23, characterized in that the sequence marker indicates the relationship between a plurality of targets.

25. The system according to any one of claims 1 to 24, characterized in that one or more of the targets overlap each other.

26. The method according to any one of claims 1 to 25, further comprising the step of repeating the step of operating the scope on a series of targets.

27. The method according to any one of claims 1 to 26, characterized in that the plurality of targets define a sequence of plurality of scope orientations with respect to a pivot point.

28. The method according to any one of claims 1 to 27, characterized in that the optical axis and the longitudinal axis are the same.

29. The method according to any one of claims 1 to 28, characterized in that the angle between the optical axis and the longitudinal axis is greater than zero and less than or equal to 90 degrees.

30. The method according to any one of claims 1 to 29, characterized in that each target defines a different scope orientation.

31. The method according to any one of claims 1 to 30, characterized in that at least one target is a projection of all four sides of the virtual rectangle, the virtual rectangle having the same aspect ratio as the frame, and the step of manipulating the scope includes a step of making all four sides of the target coincide with all four sides of the frame.

32. The virtual rectangle has two opposing parallel long sides interconnected by two opposing parallel short sides that define an aspect ratio of long side to short side which is the same as the aspect ratio of the rectangular frame, At least one target is a projection of one short side and one long side of the virtual rectangle, and the virtual rectangle has the same aspect ratio as the frame. The step of operating the scope includes the step of aligning the projection of one short side and one long side of the target with one short side and one long side of the rectangular frame. The method according to any one of claims 1 to 31, characterized by...

33. The method according to any one of claims 1 to 32, wherein the projection includes an inner circumference and an outer circumference, and the step of operating the scope includes the step of operating the scope to align the projection of the inner circumference or the outer circumference with a rectangular frame.

34. The method according to any one of claims 1 to 33, wherein the projection includes an outer circumference and four inner corners, and the step of operating the scope includes operating the scope to align the four corners with the four corners of a rectangular frame.

35. The scope has a pivot point fixed above the insert, The step of operating the scope includes the step of operating the scope around the pivot point. The method according to any one of claims 1 to 34, characterized by...

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