Previous studies have consistently demonstrated gaze behaviour differences related to expertise during various surgical procedures. In micro-neurosurgery, however, there is a lack of evidence of empirically demonstrated individual differences associated with visual attention. It is unknown exactly how neurosurgeons see a stereoscopic magnified view in the context of micro-neurosurgery and what this implies for medical training.
We report on an investigation of the eye movement patterns in micro-neurosurgery using a state-of-the-art eye tracker. We studied the eye movements of nine neurosurgeons while performing cutting and suturing tasks under a surgical microscope. Eye-movement characteristics, such as fixation (focus level) and saccade (visual search pattern), were analysed.
The results show a strong relationship between the level of microsurgical skill and the gaze pattern, whereas more expertise is associated with greater eye control, stability, and focusing in eye behaviour. For example, in the cutting task, well-trained surgeons increased their fixation durations on the operating field twice as much as the novices (expert, 848 ms; novice, 402 ms).
Maintaining steady visual attention on the target (fixation), as well as being able to quickly make eye jumps from one target to another (saccades) are two important elements for the success of neurosurgery. The captured gaze patterns can be used to improve medical education, as part of an assessment system or in a gaze-training application.
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We would like to thank all surgeons who participated in this study, and Helsinki University Hospital for enabling us to conduct this experiment.
No funding was received for this research.
Conflict of interest
For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
Microsurgical skill acquisition at an earlier stage of neurosurgery training represents an essential goal to reach an objective competence-based assessment. The analysis of the gaze patterns using eye tracking technology to quantify neurosurgeons’ focus continuity movements performing different training tasks using a neurosurgical microscope is a valuable idea. The collected data can be used to design special tasks to develop longer fixation duration or to increase the interaction between perception and action systems. Moreover, the subjective psychomotor abilities will enhance more with learning to concentrate on the objective field, reducing unnecessary distractions and optimising the microsurgical strategy. The opportune introduction of these evidences in the training processes or to integrate the technology in new neurosurgical trainingsimulators can reduce the learning curve of difficult surgical techniques, accelerate the rate for trainees to achieve surgical competency and improve patient safety.
Alex Alfieri, Lehel Török,
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Eivazi, S., Hafez, A., Fuhl, W. et al. Optimal eye movement strategies: a comparison of neurosurgeons gaze patterns when using a surgical microscope. Acta Neurochir 159, 959–966 (2017). https://doi.org/10.1007/s00701-017-3185-1
- Medical practice
- Visual attention
- Surgical training