Abstract
Introduction: Surgeons’ cognitive workload should be controlled during a surgical intervention for a successful and safe performance. Eye tracking technologies could be used for cognitive workload monitoring by analyzing the pupil size and blink frequency of surgeons. This work aims to study the surgeons’ cognitive workload watching an advanced laparoscopic video. Methods: 16 surgeons (5 experts, 11 novices) participated in the study watching a colectomy video consisting of eight steps with introductory titles. Surgeons’ gaze was recorded with eye tracking glasses while visualizing the video, from which pupil size and blink frequency were analyzed. Results: Pupil diameter of surgeons increased during the visualization of steps and decreased during the titles. Two specific steps of the intervention produced the highest pupil diameter of surgeons. When the pupil diameter increased the blink frequency decreased. Pupil diameter tended to decrease as the video is watched, which is mainly due to expert surgeons, who had a lower pupil diameter than novices. Conclusions: Eye tracking technologies allow monitoring the cognitive workload of surgeons in surgical procedures. Larger pupil size and shorter blink frequency means greater cognitive workload. Such metrics could be used to objectively label the difficult tasks within the surgical procedure. Surgical videos used for training of surgeons should be short, according to micro-learning, since cognitive workload decreases over time while visualizing them. Based on proposed metrics, eye tracking technologies could be used to distinguish the level of experience of surgeons, since cognitive workload is sensitive to the skill level of surgeons.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Edmondson, M.J., Pucher, P.H., Sriskandarajah, K., Hoare, J., Teare, J., Yang, G.Z., Darzi, A., Sodergren, M.H.: Looking towards objective quality evaluation in colonoscopy: analysis of visual gaze patterns. J. Gastroenterol. Hepatol. 31(3), 604–609 (2016)
Causer, J., McCormick, S.A., Holmes, P.S.: Congruency of gaze metrics in action, imagery and action observation. Front. Hum. Neurosci. 7, 604 (2013)
Liu, H.C., Chuang, H.H.: An examination of cognitive processing of multimedia information based on viewers’ eye movements. Interact. Learn. Environ. 19(5), 503–517 (2011)
Tien, T., Pucher, P.H., Sodergren, M.H., Sriskandarajah, K., Yang, G.Z., Darzi, A.: Differences in gaze behaviour of expert and junior surgeons performing open inguinal hernia repair. Surg. Endosc. 29(2), 405–413 (2015)
Wilson, M.R., McGrath, J.S., Vine, S.J., Brewer, J., Defriend, D., Masters, R.S.: Perceptual impairment and psychomotor control in virtual laparoscopic surgery. Surg. Endosc. 25(7), 2268–2274 (2011)
Khan, R.S., Tien, G., Atkins, M.S., Zheng, B., Panton, O.N., Meneghetti, A.T.: Analysis of eye gaze: do novice surgeons look at the same location as expert surgeons during a laparoscopic operation? Surg. Endosc. 26(12), 3536–3540 (2012)
Harvey, A., Vickers, J.N., Snelgrove, R., Scott, M.F., Sheila Morrison, S.: Expert surgeon’s quiet eye and slowing down: expertise differences in performance and quiet eye duration during identification and dissection of the recurrent laryngeal nerve. Am. J. Surg. 207(2), 187–193 (2014)
Ortega Morán, J.F., Toribio Silva, A., Pagador, J.B., Sánchez González, P., Gómez, E.J., Sánchez Margallo, F.M.: Eye gaze behaviour watching an advanced laparoscopic procedure: experts versus novices comparison. Int. J. Comput. Assist. Radiol. Surg. (IJCARS) 12(1), 133–135 (2017)
Eckstein, M.K., Guerra-carrillo, B., Singley, A.T.M., Bunge, S.A.: Beyond eye gaze: what else can eyetracking reveal about cognition and cognitive development? Dev. Cogn. Neurosci. 25, 69–91 (2016)
Zheng, B., Jiang, X., Atkins, M.S.: Detection of changes in surgical difficulty: evidence from pupil responses. Surg. Innov. 22(6), 629–635 (2015)
Zheng, B., Jiang, X., Tien, G., Meneghetti, A., Panton, O.N.M., Atkins, M.S.: Workload assessment of surgeons: correlation between NASA TLX and blinks. Surg. Endosc. 26(10), 2746–2750 (2012)
Zheng, B., Cassera, M.A., Martinec, D.V., Spaun, G.O., Swanström, L.L.: Measuring mental workload during the performance of advanced laparoscopic tasks. Surg. Endosc. 24(1), 45 (2010)
Ortega-Morán, J.F., Pagador, J.B., Sánchez-Peralta, L.F., Sánchez-González, P., Noguera, J., Burgos, D., Gómez, E.J., Sánchez-Margallo, F.M.: Validation of the three web quality dimensions of a minimally invasive surgery e-learning platform. Int. J. Med. Inform. 107, 1–10 (2017)
Callisen, L.: Why Micro Learning Is The Future Of Training In The Workplace, eLearning Industry. http://elearningindustry.com/micro-learning-future-of-training-workplace. Accessed 19 Mar 2019
Avery, A.: What is the Impact of Blended Learning Including Micro-Learning on Manager Learning and Behavior Change vs. Impact of Classroom Learning? (2016)
Optimal Video Length for Training Videos, analysis by Philip Guo, Xcelus. http://www.xcelus.com/optimal-video-length-training-videos/. Accessed 19 Mar 2019
Kon, H., Botelho, M.G., Bridges, S., Leung, K.C.M.: The impact of complete denture making instructional videos on self-directed learning of clinical skills. J. Prosthodont. Res. 59(2), 144–151 (2015)
Fichtel, E., Lau, N., Park, J., Parker, S.H., Ponnala, S., Fitzgibbons, S., Safford, S.D.: Eye tracking in surgical education: gaze-based dynamic area of interest can discriminate adverse events and expertise. Surg. Endosc. 33, 1–8 (2018)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Ethics declarations
The authors declare that they have no conflict of interest.
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this paper
Cite this paper
Ortega-Morán, J.F., Pagador, J.B., Luis-del-Campo, V., Gómez-Blanco, J.C., Sánchez-Margallo, F.M. (2020). Using Eye Tracking to Analyze Surgeons’ Cognitive Workload During an Advanced Laparoscopic Procedure. In: Henriques, J., Neves, N., de Carvalho, P. (eds) XV Mediterranean Conference on Medical and Biological Engineering and Computing – MEDICON 2019. MEDICON 2019. IFMBE Proceedings, vol 76. Springer, Cham. https://doi.org/10.1007/978-3-030-31635-8_1
Download citation
DOI: https://doi.org/10.1007/978-3-030-31635-8_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-31634-1
Online ISBN: 978-3-030-31635-8
eBook Packages: EngineeringEngineering (R0)