Gaze entropy reflects surgical task load
- 571 Downloads
Task (over-)load imposed on surgeons is a main contributing factor to surgical errors. Recent research has shown that gaze metrics represent a valid and objective index to asses operator task load in non-surgical scenarios. Thus, gaze metrics have the potential to improve workplace safety by providing accurate measurements of task load variations. However, the direct relationship between gaze metrics and surgical task load has not been investigated yet. We studied the effects of surgical task complexity on the gaze metrics of surgical trainees.
We recorded the eye movements of 18 surgical residents, using a mobile eye tracker system, during the performance of three high-fidelity virtual simulations of laparoscopic exercises of increasing complexity level: Clip Applying exercise, Cutting Big exercise, and Translocation of Objects exercise. We also measured performance accuracy and subjective rating of complexity.
Gaze entropy and velocity linearly increased with increased task complexity: Visual exploration pattern became less stereotyped (i.e., more random) and faster during the more complex exercises. Residents performed better the Clip Applying exercise and the Cutting Big exercise than the Translocation of Objects exercise and their perceived task complexity differed accordingly.
Our data show that gaze metrics are a valid and reliable surgical task load index. These findings have potential impacts to improve patient safety by providing accurate measurements of surgeon task (over-)load and might provide future indices to assess residents’ learning curves, independently of expensive virtual simulators or time-consuming expert evaluation.
KeywordsEye metrics Neuroergonomics Surgical skills assessment Patient safety Saccades
We thank the Tobii Group for the EyeTrackAwards Stipend awarded to LLDS, and the IAVANTE staff (Andalusian Public Foundation for Progress and Health) for their help during the data collection. This study was funded by the Campus of International Excellence (BioTic Granada) Research Programme (Research Project V7-2015 to CDP). The project was approved by the Talentia Postdoc Program launched by the Andalusian Knowledge Agency, co-funded by the European Commission’s 7th Framework Programme for Research and Technological Development—Marie Skłodowska-Curie actions—and the Andalusian Department of Economy, Innovation, Science and Employment (COFUND—Grant Agreement No. 267226 to LLDS). Research by LLDS is funded by the BBVA Foundation Program for Research, Innovation, and Cultural Creation (Grant No. 2015-2). CDP is supported by a UGR Postdoctoral Fellowship (2013 University of Granada Research Plan). Research by AC is funded by a Spanish Ministry of Economy and Competitiveness grant (PSI2012-39292 to AC). Research by LLDS, CDP, and AC is funded by a Spanish Department of Transportation grant (SPIP2014-1426 to LLDS).
Compliance with ethical standards
Leandro L. Di Stasi, Carolina Diaz-Piedra, Héctor Rieiro, José M. Sánchez Carrión, Mercedes Martin Berrido, Gonzalo Olivares, and Andrés Catena have no conflicts of interest or financial ties to disclose.
- 5.Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201:369–373. doi: 10.1016/j.amjsurg.2010.09.012 CrossRefPubMedGoogle Scholar
- 6.Islam A, Castellvi AO, Tesfay ST, Castellvi AD, Wright AS, Scott DJ (2011) Early surgeon impressions and technical difficulty associated with laparoendoscopic single-site surgery: a Society of American Gastrointestinal and Endoscopic Surgeons learning center study. Surg Endosc 25:2597–2603. doi: 10.1007/s00464-011-1594-4 CrossRefPubMedGoogle Scholar
- 13.Hart SG (2006) NASA-task load index (NASA-TLX); 20 years later. In: Proceedings of the human factors and ergonomics society annual meeting, pp 904–908Google Scholar
- 17.Sodergren M, McGregor C, Farne HA, Cao J, Lv Z, Purkayastha S, Athanasiou T, Darzi A, Paraskeva P (2013) A randomised comparative study evaluating learning curves of novices in a basic single-incision laparoscopic surgery task. J Gastrointest Surg Off J Soc Surg Aliment Tract 17:569–575. doi: 10.1007/s11605-012-2113-1 CrossRefGoogle Scholar
- 24.Krupinski EA, Tillack AA, Richter L, Henderson JT, Bhattacharyya AK, Scott KM, Graham AR, Descour MR, Davis JR, Weinstein RS (2006) Eye-movement study and human performance using telepathology virtual slides. Implications for medical education and differences with experience. Hum Pathol 37:1543–1556. doi: 10.1016/j.humpath.2006.08.024 CrossRefPubMedGoogle Scholar
- 25.Alzubaidi M, Patel A, Panchanathan S, Black J, John A (2010) Reading a radiologist’s mind: monitoring rising and falling interest levels while scanning chest X-rays. In: Proceedings of the SPIE international society for optical engineering. San Diego, CA, USA, pp 0F1–0F10Google Scholar
- 27.Cao Y, Miura S, Kobayashi Y, Kawamura K, Sugano S, Fujie M (2016) Pupil variation applied to the eye tracking control of an endoscopic manipulator. IEEE Robot Autom Lett 1–1. doi: 10.1109/LRA.2016.2521894
- 29.Eivazi S, Bednarik R, Tukiainen M, von und zu Fraunberg M, Leinonen V, Jääskeläinen JE (2012) Gaze behaviour of expert and novice microneurosurgeons differs during observations of tumor removal recordings. In: Proceedings of the symposium on eye tracking research and applications. New York, NY, USA, pp 377–380Google Scholar
- 31.Giovinco NA, Sutton SM, Miller JD, Rankin TM, Gonzalez GW, Najafi B, Armstrong DG (2015) A passing glance? Differences in eye tracking and gaze patterns between trainees and experts reading plain film bunion radiographs. J Foot Ankle Surg 54:382–391. doi: 10.1053/j.jfas.2014.08.013 CrossRefPubMedGoogle Scholar
- 37.Beatty J, Lucero-Wagoner B (2000) The pupillary system. In: Cacioppo JT, Tassinary LG, Berntson GG (eds) Handbook of psychophysiology, 2nd edn. Cambridge University Press, New York, pp 142–162Google Scholar
- 39.Morales JM, Di Stasi LL, Diaz-Piedra C, Morillas C, Romero S (2015) Real-time monitoring of biomedical signals to improve road safety. Springer, Palma de Mallorca, pp 89–97Google Scholar
- 45.Di Stasi LL, Diaz-Piedra C, Suárez J, McCamy MB, Martinez-Conde S, Roca-Dorda J, Catena A (2015) Task complexity modulates pilot electroencephalographic activity during real flights. Psychophysiology. doi: 10.1111/psyp.12419
- 48.Corker HP, Singh P, Sodergren MH, Balaji S, Kwasnicki RM, Darzi AW, Paraskeva P (2015) A randomized controlled study to establish the effect of articulating instruments on performance in single-incision laparoscopic surgery. J Surg Educ 72:1–7. doi: 10.1016/j.jsurg.2014.08.004 CrossRefPubMedGoogle Scholar
- 49.Fransen SAF, Mertens LS, Botden SMBI, Stassen LPS, Bouvy ND (2011) Performance curve of basic skills in single-incision laparoscopy versus conventional laparoscopy: Is it really more difficult for the novice? Surg Endosc 26:1231–1237. doi: 10.1007/s00464-011-2041-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 50.Borg G (1998) Borg’s perceived exertion and pain scales. Human Kinetics Publishers, ChampaignGoogle Scholar
- 55.Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70Google Scholar