Towards understanding expert eye behaviors in laparoscopic surgery

Laparoscopic surgery is a visually-guided manual task requiring mastery of non-intuitive motor mapping and detailed procedural knowledge for decision-making. Earlier research studies with unfamiliar motor tasks have shown novices make distinct changes in gaze behavior as the necessary manual skills are acquired. Although the basic manual skills are used repeatedly, successful completion of a specific task instance is still dependent on execution of a well-informed motor plan on internalized visual information. While other researchers have been able to use certain eye metrics to quantify expertise for some tasks, we have conducted various additional studies exploring different eye movement patterns as well as a combination of eye and manual parameters for identifying differences between expert and novice eye-hand coordination patterns. Still, expertise is consistently correlated with a clear difference in task completion time. This research covers a series of eye tracking studies conducted in laparoscopic training environments and in the real operating room. Subsequent analyses prompted efforts to improve data quality and led to development of an instantaneous measure combining eye tracking and manual movement data, to describe expert and novice eye-hand coordination behavior. This knowledge suggests the possibility of applying training protocols in the future to directly manipulate the development of eye-hand coordination in surgical trainees for rapidly improving task performance.