Surgical Endoscopy

, Volume 26, Issue 10, pp 2746–2750 | Cite as

Workload assessment of surgeons: correlation between NASA TLX and blinks

  • Bin ZhengEmail author
  • Xianta Jiang
  • Geoffrey Tien
  • Adam Meneghetti
  • O. Neely M. Panton
  • M. Stella Atkins



Blinks are known as an indicator of visual attention and mental stress. In this study, surgeons’ mental workload was evaluated utilizing a paper assessment instrument (National Aeronautics and Space Administration Task Load Index, NASA TLX) and by examining their eye blinks. Correlation between these two assessments was reported.


Surgeons’ eye motions were video-recorded using a head-mounted eye-tracker while the surgeons performed a laparoscopic procedure on a virtual reality trainer. Blink frequency and duration were computed using computer vision technology. The level of workload experienced during the procedure was reported by surgeons using the NASA TLX.


A total of 42 valid videos were recorded from 23 surgeons. After blinks were computed, videos were divided into two groups based on the blink frequency: infrequent group (≤6 blinks/min) and frequent group (more than 6 blinks/min). Surgical performance (measured by task time and trajectories of tool tips) was not significantly different between these two groups, but NASA TLX scores were significantly different. Surgeons who blinked infrequently reported a higher level of frustration (46 vs. 34, P = 0.047) and higher overall level of workload (57 vs. 47, P = 0.045) than those who blinked more frequently. The correlation coefficients (Pearson test) between NASA TLX and the blink frequency and duration were −0.17 and 0.446.


Reduction of blink frequency and shorter blink duration matched the increasing level of mental workload reported by surgeons. The value of using eye-tracking technology for assessment of surgeon mental workload was shown.


Endoscopy training Simulation Mental workloads Eye-tracking Surgical education Patient safety 



We thank the Canadian Natural Sciences and Engineering Research Council (NSERC) and the Royal College of Physicians and Surgeons in Canada (RCPSC) Medical Education Research Grant for funding this project.


Dr. Neely Panton receives funds from Ethicon Endo-Surgery for fellow education and is on the scientific advisory board of Ethicon Endo-Surgery. Dr. Bin Zheng, Xianta Jiang, Geoffrey Tien, Dr. Adam Meneghetti, and Dr. Stella Atkins have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Bin Zheng
    • 1
    Email author
  • Xianta Jiang
    • 2
  • Geoffrey Tien
    • 2
  • Adam Meneghetti
    • 3
  • O. Neely M. Panton
    • 3
  • M. Stella Atkins
    • 2
  1. 1.Department of Surgery, 3-002F Li Ka Shing Centre for Health Research InnovationUniversity of AlbertaEdmontonCanada
  2. 2.Computing ScienceSimon Fraser UniversityBurnabyCanada
  3. 3.Department of SurgeryUniversity of British ColumbiaVancouverCanada

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