Gaze Training Improves Technical Performance and Resistance to Distractions in Virtual Laparoscopic Surgery

Mark Wilson, Sam Vine, James Brewer, Elizabeth Bright, Rich Masters, John McGrath. University of Exeter

OBJECTIVES: The operating room environment is replete with stressors and distractions that increase the attentional demands of what are already complex psychomotor procedures. As the attentional control of novices appears to be particularly disrupted by auditory distractions, helping trainees to minimize such cognitive overloading should be considered an important aspect of surgical training. Contemporary research in other fields (e.g., sport) has revealed that gaze training interventions may develop robust movement skills. The aim of the current study was to examine the utility of such an intervention in protecting technical laparoscopic skills under attentionally demanding and distracting multi-tasking conditions.

METHODS AND PROCEDURES: Twenty medical trainees with no laparoscopic experience were divided randomly into one of two treatment groups: A gaze training (GAZE), and a movement training (MOVE) group. Participants were fitted with a Mobile Eye gaze registration system, which measures eye-line of gaze at 25Hz. Training consisted of ten repetitions of the ‘eye-hand coordination’ task from the LAP Mentor VR laparoscopic surgical simulator. The GAZE group watched a video revealing the gaze control of an expert surgeon performing the task, and received video feedback of their gaze control on subsequent attempts. The MOVE group watched a video revealing the tool control of an expert surgeon performing the task, and received video feedback of their tool control on subsequent attempts. After training, all participants completed a retention test (designed to assess learning) and a transfer test, in which they completed the procedure while performing a concurrent tone counting task (distinguishing one tone from 3 other distracting tones). Completion time data were downloaded from the LAP Mentor feedback software and subjected to a 2 (Group) x 2 (Test) ANOVA.

RESULTS: There were significant main effects for group, F(1,18) = 16.26, p < .005, ES = .48; and test, F(1,18) = 21.41, p < .001, ES = .54; and a significant interaction effect, F(1,18) = 15.84, p < .005, ES = .47.

See Table 1 below for the completion time results in seconds (means ± SD).

CONCLUSIONS: The results suggest that gaze training may have a place alongside more traditional training of movement patterns. Not only did the GAZE group learn more quickly than the MOVE group (better performance in the retention test), they showed no degradation of performance under concurrent task loading (transfer test). These results suggest that although the intervention focused on training gaze behavior only, there were indirect benefits for movement behaviors and performance efficiency: Improving gaze aided the self-organization of motor skill without direct coaching of the motor behavior. Additionally, focusing on a single external target, rather than on complex movement patterns, may have freed-up attention resources, which could be applied to concurrent cognitive tasks. As surgical performance relies on more than just technical proficiency, this finding has interesting clinical utility.