Analysis of Eye Gaze: Do Novice Surgeons Look at the Same Location As Expert Surgeons During a Laparoscopic Operation?

Rana Khan, MD, Geoffrey Tien, Stella Atkins, Bin Zheng, MD, Ormond N Panton, MD, Adam T Meneghetti, MD MHSc. UNIVERSITY OF BRITISH COLUMBIA, SIMON FRASER UNIVERSITY

Introduction:
The purpose of this study is to see if eye-tracking technology can be used to detect differences in the eye gaze pattern between expert and novice surgeons.
Eye-tracking technology is currently being evaluated as a potential educational and assessment tool in surgical training. It can be used to track where a surgeon is looking during a procedure both in the lab and in the real operating room environment.

Methods
Data collection required three phases. Phase 1 involved recording the real time eye-gaze of three expert surgeons while they performed laparoscopic procedures in the operating room. The video from these operations was saved and used for Phase 2.
Phase 2 involved showing the recorded video after a few months to the same expert surgeons while they were sitting in a controlled lab environment, and their eye gaze patterns were recorded.
In Phase 3, junior residents (PGY 1-3) were shown the recorded video operations and their eye-gaze was recorded.
The eye gaze patterns from Phase 1 and Phase 2 were compared after superimposing on each other. The Phase 2 and Phase 3 recordings were also compared to each other.
Eye gaze patterns were considered “overlapped” when the distance between two gaze points was less than 90 pixels. Percentage of overlap time was based on the entire procedure time.

Results
There were sixteen Phase 1 recordings from three expert surgeons. Phase 2 recordings were obtained after a mean of 138 days. Twenty eye-tracking recordings were obtained from junior residents. Expert surgeons showed a 55% overlap of eye gaze pattern from Phase 1 to Phase 2 (doing vs. watching only). Junior residents showed only a 43.8% overlap when compared to the eye gaze pattern of the expert surgeons (p 0.001).

Conclusions
These findings show that there is a significant difference in eye gaze pattern between novice and expert surgeons while watching a laparoscopic operation. In addition, eye gaze patterns differ when a surgeon is performing an operation versus watching the operation in a controlled environment. This technology can potentially expedite the learning curve for various laparoscopic procedures by teaching surgeons-in-training to follow the eye gaze location of expert surgeons.