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Virtual pointer for gaze guidance in laparoscopic surgery

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Abstract

Background

A challenge of laparoscopic surgery is learning how to interpret the indirect view of the operative field. Acquiring professional vision—understanding what to see and which information to attend to, is thereby an essential part of laparoscopic training and one in which trainers exert great effort to convey. We designed a virtual pointer (VP) that enables experts to point or draw free-hand sketches over an intraoperative laparoscopic video for a novice to see. This study aimed to investigate the efficacy of the virtual pointer in guiding novices’ gaze patterns.

Methods

We conducted a counter-balanced, within-subject trial to compare the novices’ gaze behaviors in laparoscopic training with the virtual pointer compared to a standard training condition, i.e., verbal instruction with un-mediated gestures. In the study, seven trainees performed four simulated laparoscopic tasks guided by an experienced surgeon as the trainer. A Tobii Pro X3-120 eye-tracker was used to capture the trainees’ eye movements. The measures include fixation rate, i.e., the frequency of trainees’ fixations, saccade amplitude, and fixation concentration, i.e., the closeness of trainees’ fixations.

Results

No significant difference in fixation rate or saccade amplitude was found between the virtual pointer condition and the standard condition. In the virtual pointer condition, trainees’ fixations were more concentrated (p = 0.039) and longer fixations were more clustered, compared to the Standard condition (p = 0.008).

Conclusions

The virtual pointer effectively improved surgical trainees’ in-the-moment gaze focus during the laparoscopic training by reducing their gaze dispersion and concentrating their attention on the anatomical target. These results suggest that technologies which support gaze training should be expert-driven and intraoperative to efficiently modify novices’ gaze behaviors.

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Acknowledgements

The authors would like to acknowledge Dr. Timothy Turner for his support in preparing for data collection and the SAIL Center at Anne Arundel Medical Center for providing the equipment and space. This work was sponsored by NSF Grant IIS #1422671 and #1552837.

Funding

This study is sponsored by National Science Foundation Grant IIS #1422671 and #1552837.

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Authors and Affiliations

  1. Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, USA

    Yuanyuan Feng, Hannah McGowan, Azin Semsar, Andrea Kleinsmith & Helena Mentis

  2. Department of Surgery, Anna Arundel Medical Center, Annapolis, MD, USA

    Hamid R. Zahiri & Adrian Park

  3. Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA

    Ivan M. George

Authors
  1. Yuanyuan Feng
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  2. Hannah McGowan
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  3. Azin Semsar
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  4. Hamid R. Zahiri
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  5. Ivan M. George
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  6. Adrian Park
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  7. Andrea Kleinsmith
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  8. Helena Mentis
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Corresponding author

Correspondence to Yuanyuan Feng.

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Disclosures

Ms. Feng, Ms. McGowan, Ms. Semsar, Dr. Zahiri, Mr. George, Dr. Park, Dr. Kleinsmith, and Dr. Mentis have no conflicts of interest or financial ties to disclose.

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Feng, Y., McGowan, H., Semsar, A. et al. Virtual pointer for gaze guidance in laparoscopic surgery. Surg Endosc 34, 3533–3539 (2020). https://doi.org/10.1007/s00464-019-07141-x

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  • DOI: https://doi.org/10.1007/s00464-019-07141-x

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