Perceptual impairment and psychomotor control in virtual laparoscopic surgery

Mark R Wilson, John S McGrath, Samuel J Vine, James Brewer, David Defriend, Richard S W Masters, Mark R Wilson, John S McGrath, Samuel J Vine, James Brewer, David Defriend, Richard S W Masters

Abstract

Background: It is recognised that one of the major difficulties in performing laparoscopic surgery is the translation of two-dimensional video image information to a three-dimensional working area. However, research has tended to ignore the gaze and eye-hand coordination strategies employed by laparoscopic surgeons as they attempt to overcome these perceptual constraints. This study sought to examine if measures related to tool movements, gaze strategy, and eye-hand coordination (the quiet eye) differentiate between experienced and novice operators performing a two-handed manoeuvres task on a virtual reality laparoscopic surgical simulator (LAP Mentor™).

Methods: Twenty-five right-handed surgeons were categorised as being either experienced (having led more than 60 laparoscopic procedures) or novice (having performed fewer than 10 procedures) operators. The 10 experienced and 15 novice surgeons completed the "two-hand manoeuvres" task from the LAP Mentor basic skills learning environment while wearing a gaze registration system. Performance, movement, gaze, and eye-hand coordination parameters were recorded and compared between groups.

Results: The experienced surgeons completed the task significantly more quickly than the novices, used significantly fewer movements, and displayed shorter tool paths. Gaze analyses revealed that experienced surgeons spent significantly more time fixating the target locations than novices, who split their time between focusing on the targets and tracking the tools. A more detailed analysis of a difficult subcomponent of the task revealed that experienced operators used a significantly longer aiming fixation (the quiet eye period) to guide precision grasping movements and hence needed fewer grasp attempts.

Conclusion: The findings of the study provide further support for the utility of examining strategic gaze behaviour and eye-hand coordination measures to help further our understanding of how experienced surgeons attempt to overcome the perceptual difficulties inherent in the laparoscopic environment.

Figures

Fig. 1
Fig. 1
Images of the LAP Mentor™ environment showing representative examples of the “two-handed manoeuvres” task: grasping and manipulating the jelly to reveal a ball (A), grasping a ball (B), and dropping a ball in the endobag (C)
Fig. 2
Fig. 2
The head-mounted unit from the ASL Mobile Eye gaze registration system (A) and the software environment (B) showing the pupil, the corneal reflection, and the vector line between the two
Fig. 3
Fig. 3
The percentage of total fixation duration to target (jelly, ball, or endobag) and tool for novice and experienced surgeons (±SEM)

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