Context dependent gaze metrics, derived from eye movements explicitly associated with how a task is being performed, are particularly useful for formative assessment that includes feedback on specific behavioral adjustments for skill acquisitions. In laparoscopic surgery, context dependent gaze metrics are under investigated and commonly derived by either qualitatively inspecting the videos frame by frame or mapping the fixations onto a static surgical task field. This study collected eye-tracking and video data from 13 trainees practicing the peg transfer task. Machine learning algorithms in computer vision were employed to derive metrics of tool speed, fixation rate on (moving or stationary) target objects, and fixation rate on tool-object combination. Preliminary results from a clustering analysis on the measurements from 499 practice trials indicated that the metrics were able to differentiate three skill levels amongst the trainees, suggesting high sensitivity and potential of context dependent gaze metrics for surgical assessment.
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References
1.
AhmidiN.HagerG. D.IshiiL.FichtingerG.GalliaG. L.IshiiM. (2010). Surgical task and skill classification from eye tracking and tool motion in minimally invasive surgery. Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 6363 LNCS(PART 3), 295–302. https://doi.org/10.1007/978-3-642-15711-0_37
2.
BonrathE. M.WeberB. K.FritzM.MeesS. T.WoltersH. H.SenningerN.RijckenE. (2012). Laparoscopic simulation training: Testing for skill acquisition and retention. Surgery (United States), 152(1), 12–20. https://doi.org/10.1016/j.surg.2011.12.036
FeldmanL. S.HagartyS. E.GhitulescuG.StanbridgeD.FriedG. M. (2004). Relationship between objective assessment of technical skills and subjective in-training evaluations in surgical residents. Journal of the American College of Surgeons, 198(1), 105–110. https://doi.org/10.1016/j.jamcollsurg.2003.08.020
5.
FengY.Mcgowan·HannahSemsarA.ZahiriH. R.GeorgeI. M.ParkA.KleinsmithA.MentisH. (2020). Virtual pointer for gaze guidance in laparoscopic surgery. 34, 3533–3539. https://doi.org/10.1007/s00464-019-07141-x
6.
FichtelE.LauN.ParkJ.Henrickson ParkerS.PonnalaS.FitzgibbonsS.SaffordS. D. (2019). Eye tracking in surgical education: gaze-based dynamic area of interest can discriminate adverse events and expertise. Surgical Endoscopy, 33(7), 2249–2256. https://doi.org/10.1007/s00464-018-6513-5
7.
LawB.LomaxA. J.AtkinsM. S.MackenzieC. L.KirkpatrickA. E. (2004). Eye gaze patterns differentiate novice and experts in a virtual laparoscopic surgery training environment. Eye Tracking Research and Applications Symposium (ETRA), 41–47. https://doi.org/10.1145/968363.968370
8.
LeeW. J.ChanC. P.WangB. Y. (2013). Recent advances in laparoscopic surgery. Asian Journal of Endoscopic Surgery, 6(1), 1–8. https://doi.org/10.1111/ases.12001
9.
LiuS.DonaldsonR.SubramaniamA.PalmerH.ChampionC.CoxM.AppelbaumL. G. (2020). Skill acquisition and gaze behavior during laparoscopic surgical simulation. https://doi.org/10.1101/2020.07.17.206763
10.
Menekse DalverenG. G.CagiltayN. E. (2020). Distinguishing Intermediate and Novice Surgeons by Eye Movements. Frontiers in Psychology, 11, 2330. https://doi.org/10.3389/fpsyg.2020.542752
11.
NewellA.YangK.DengJ. (2016). Stacked hourglass networks for human pose estimation. Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 9912 LNCS, 483–499. https://doi.org/10.1007/978-3319-46484-8_29
12.
NovitskyY. W.LitwinD. E. M.CalleryM. P. (2004). The net immunologic advantage of laparoscopic surgery. In Surgical Endoscopy and Other Interventional Techniques (Vol. 18, Issue 10, pp. 1411–1419). Springer. https://doi.org/10.1007/s00464-003-8275-x
13.
OropesaI.Sánchez-GonzálezP.LamataP.ChmarraM. K.PagadorJ. B.Sánchez-MargalloJ. A.Sánchez-MargalloF. M.GómezE. J. (2011). Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery. In Journal of Surgical Research (Vol. 171, Issue 1). Academic Press Inc. https://doi.org/10.1016/j.jss.2011.06.034
14.
PetersJ. H.EllisonE. C.InnesJ. T.LissJ. L.NicholsK. E.LomanoJ. M.RobyS. R.FrontM. E.CareyL. C. (1991). Safety and efficacy of laparoscopic cholecystectomy: A Prospective analysis of 100 initial patients. Annals of Surgery, 213(1), 3–12. https://doi.org/10.1097/00000658-199101000-00002
15.
RichstoneL.SchwartzM. J.SeidemanC.CadedduJ.MarshallS.KavoussiL. R. (2010). Eye metrics as an objective assessment of surgical skill. Annals of Surgery, 252(1), 177–182. https://doi.org/10.1097/SLA.0b013e3181e464fb
16.
RidlerT. W.CalvardS. (1978). PICTURE THRESHOLDING USING AN ITERATIVE SLECTION METHOD. IEEE Transactions on Systems, Man and Cybernetics, SMC-8(8), 630–632. https://doi.org/10.1109/tsmc.1978.4310039
17.
SodergrenM. H.Orihuela-EspinaF.ClarkJ.TeareJ.YangG. Z.DarziA. (2010). Evaluation of orientation strategies in laparoscopic cholecystectomy. Annals of Surgery, 252(6), 1027–1036. https://doi.org/10.1097/SLA.0b013e3181e49683
18.
SrokaG.FeldmanL. S.VassiliouM. C.KanevaP. A.FayezR.FriedG. M. (2010). Fundamentals of Laparoscopic Surgery simulator training to proficiency improves laparoscopic performance in the operating room-a randomized controlled trial. American Journal of Surgery, 199(1), 115–120. https://doi.org/10.1016/j.amjsurg.2009.07.035
19.
VillegasL.SchneiderB. E.CalleryM. P.JonesD. B. (2003). Laparoscopic skills training. Surgical Endoscopy and Other Interventional Techniques, 17(12), 1879–1888. https://doi.org/10.1007/s00464-003-8172-3
20.
Von Strauss Und TorneyM.Dell-KusterS.MecheraR.RosenthalR.LangerI. (2012). The cost of surgical training: Analysis of operative time for laparoscopic cholecystectomy. Surgical Endoscopy, 26(9), 2579–2586. https://doi.org/10.1007/s00464-012-2236-1
21.
WilsonM.McGrathJ.VineS.BrewerJ.DefriendD.MastersR. (2010). Psychomotor control in a virtual laparoscopic surgery training environment: Gaze control parameters differentiate novices from experts. Surgical Endoscopy, 24(10), 2458–2464. https://doi.org/10.1007/s00464-010-0986-1
22.
YamaguchiS.KonishiK.YasunagaT.YoshidaD.KinjoN.KobayashiK.IeiriS.OkazakiK.NakashimaH.TanoueK.MaeharaY.HashizumeM. (2007). Construct validity for eye-hand coordination skill on a virtual reality laparoscopic surgical simulator. Surgical Endoscopy and Other Interventional Techniques, 21(12), 2253–2257. https://doi.org/10.1007/s00464-007-9362-1
23.
ZendejasB.JakubJ. W.TerandoA. M.SarnaikA.AriyanC. E.FariesM. B.ZaniS.NeumanH. B.WasifN.FarmaJ. M.AverbookB. J.BilimoriaK. Y.TylerD.BradyM. S.FarleyD. R. (2017). Laparoscopic skill assessment of practicing surgeons prior to enrollment in a surgical trial of a new laparoscopic procedure. Surgical Endoscopy, 31(8), 3313–3319. https://doi.org/10.1007/s00464-0165364-1
