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Gaze behavior is related to objective technical skills assessment during virtual reality simulator-based surgical training: a proof of concept

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Simulation-based training allows surgical skills to be learned safely. Most virtual reality-based surgical simulators address technical skills without considering non-technical skills, such as gaze use. In this study, we investigated surgeons’ visual behavior during virtual reality-based surgical training where visual guidance is provided. Our hypothesis was that the gaze distribution in the environment is correlated with the simulator’s technical skills assessment.

Methods

We recorded 25 surgical training sessions on an arthroscopic simulator. Trainees were equipped with a head-mounted eye-tracking device. A U-net was trained on two sessions to segment three simulator-specific areas of interest (AoI) and the background, to quantify gaze distribution. We tested whether the percentage of gazes in those areas was correlated with the simulator’s scores.

Results

The neural network was able to segment all AoI with a mean Intersection over Union superior to 94% for each area. The gaze percentage in the AoI differed among trainees. Despite several sources of data loss, we found significant correlations between gaze position and the simulator scores. For instance, trainees obtained better procedural scores when their gaze focused on the virtual assistance (Spearman correlation test, N = 7, r = 0.800, p = 0.031).

Conclusion

Our findings suggest that visual behavior should be quantified for assessing surgical expertise in simulation-based training environments, especially when visual guidance is provided. Ultimately visual behavior could be used to quantitatively assess surgeons’ learning curve and expertise while training on VR simulators, in a way that complements existing metrics.

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Acknowledgements

This study is part of the French network of University Hospitals HUGO (“Hôpitaux Universitaires du Grand Ouest”). It was made possible thanks to the VirtaMed Society.

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Authors and Affiliations

  1. LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France

    Soline Galuret, Nicolas Vallée, Alexandre Tronchot, Hervé Thomazeau, Pierre Jannin & Arnaud Huaulmé

  2. Orthopedics and Trauma Department, Rennes University Hospital, 35000, Rennes, France

    Nicolas Vallée, Alexandre Tronchot & Hervé Thomazeau

Authors
  1. Soline Galuret
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  2. Nicolas Vallée
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  3. Alexandre Tronchot
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  4. Hervé Thomazeau
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  5. Pierre Jannin
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  6. Arnaud Huaulmé
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Correspondence to Pierre Jannin.

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All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Galuret, S., Vallée, N., Tronchot, A. et al. Gaze behavior is related to objective technical skills assessment during virtual reality simulator-based surgical training: a proof of concept. Int J CARS 18, 1697–1705 (2023). https://doi.org/10.1007/s11548-023-02961-8

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  • DOI: https://doi.org/10.1007/s11548-023-02961-8

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