Using Key Distance to Clarify a Theory on the SNARC

Sensorimotor Challenges in Minimally Invasive Surgery: A Theoretically-Oriented Review

OBJECTIVE

This review surveys the literature on sensorimotor challenges impacting performance in laparoscopic minimally invasive surgery (MIS).

BACKGROUND

Despite its well-known benefits for patients, achieving proficiency in MIS can be challenging for surgeons due to many factors including altered visual perspectives and fulcrum effects in instrument handling. Research on these and other sensorimotor challenges has been hindered by imprecise terminology and the lack of a unified theoretical framework to guide research questions in the field.

METHOD

We conducted a systematic survey of the MIS literature, focusing on studies investigating sensorimotor challenges affecting laparoscopic performance. To provide a common foundation for cross-study comparisons, we propose a standardized taxonomy that distinguishes between different experimental paradigms used in the literature. We then show how the computational motor learning perspective provides a unifying theoretical framework for the field that can facilitate progress and motivate future research along clearer, hypothesis-driven lines.

RESULTS

The survey identified diverse sensorimotor perturbations in MIS, which can be effectively categorized according to our proposed taxonomy. Studies investigating monitor-, camera-, and tool-based perturbations were systematically analyzed, elucidating their impact on surgical performance. We also show how the computational motor learning perspective provides deeper insights and potential strategies to mitigate challenges.

CONCLUSION

Sensorimotor challenges significantly impact MIS, necessitating a systematic, empirically informed approach. Our proposed taxonomy and theoretical framework shed light on the complexities involved, paving the way for more structured research and targeted training approaches to enhance surgical proficiency.

APPLICATION

Understanding the sensorimotor challenges inherent to MIS can guide the design of improved training curricula and inform the configuration of setups in the operating room to enhance surgeon performance and ultimately patient outcomes. This review offers key insights for surgeons, educators, and researchers in surgical performance and technology development.

Different effects of spatial separation in action and perception

Spatial distance of response keys has been shown to have an effect on nonspatial tasks in that performance improved if the spatial distance increased. Comparably, spatial distance of stimulus features has been shown to have a performance-improving effect in a (partly) spatial task. Here, we combined these two findings in the same task to test for the commonality of the effect of stimulus distance and the effect of response distance. Thus, we varied spatial distance in exactly the same fashion either between stimuli or between responses in a standard Eriksen flanker task. The results show that spatial distance only affected the processing of stimulus features, while it had no effect on the processing of response features. Regarding the idea of common coding of action and perception (Prinz, 1990), stimulus and response processing should be influenced by spatial distance in the same way so that our data might suggest a boundary for the idea of common coding.

SNARC compatibility triggers positive affect

Previous research on the spatial-numerical association of response codes (SNARC) has demonstrated that SNARC-compatible digit arrangements are processed faster and more accurately than SNARC-incompatible arrangements. Concurrently, processing speed and accuracy have been conceptualised as indicating processing fluency - the ease of information processing - which has been shown to entail affective downstream consequences. Bridging these two research lines for the first time, we investigated whether digit arrangements that are compatible to this association are affectively preferred to association-incompatible digit arrangements. In a line of four experiments (total N = 786), German participants were asked to indicate how much they like the overall appearance of two digits that appear at the right and at the left side of the screen. Results from three of the four experiments suggest that digit arrangements that are compatible with this spatial-numerical association indeed trigger positive feelings. These preference patterns were not moderated by the horizontal distance between the two digits, pointing towards a stable phenomenon that is insensitive to contextual spatial cues.

The SNARC Effect in Chinese Numerals: Do Visual Properties of Characters and Hand Signs Influence Number Processing?

The SNARC effect refers to an association of numbers and spatial properties of responses that is commonly thought to be amodal and independent of stimulus notation. We tested for a horizontal SNARC effect using Arabic digits, simple-form Chinese characters and Chinese hand signs in participants from Mainland China. We found a horizontal SNARC effect in all notations. This is the first time that a horizontal SNARC effect has been demonstrated in Chinese characters and Chinese hand signs. We tested for the SNARC effect in two experiments (parity judgement and magnitude judgement). The parity judgement task yielded clear, consistent SNARC effects in all notations, whereas results were more mixed in magnitude judgement. Both Chinese characters and Chinese hand signs are represented non-symbolically for low numbers and symbolically for higher numbers, allowing us to contrast within the same notation the effects of heavily learned non-symbolic vs. symbolic representation on the processing of numbers. In addition to finding a horizontal SNARC effect, we also found a robust numerical distance effect in all notations. This is particularly interesting as it persisted when participants reported using purely visual features to solve the task, thereby suggesting that numbers were processed semantically even when the task could be solved without the semantic information.