S. Erridge1, H. Ashraf1, S. Purkayastha1, A. Darzi1, M. H. Sodergren1 1Imperial College London,Department Of Surgery & Cancer,London, London, United Kingdom
Introduction: Bariatric surgery has been shown to significantly decrease the physiological and economic burden of obesity in select groups of patients. Eye tracking presents a novel tool that may objectively profile skill levels in surgery. The primary objective of this study was to identify differences in gaze behaviours between expert and junior surgeons performing a laparoscopic roux-en-y gastric bypass (LRYGB).
Methods: This prospective observational study utilised lightweight eye tracking apparatus to determine the difference in gaze behaviours between expert (>75 cases performed) and junior surgeons (<75 cases) at defined stages of LRYGB. Primary endpoints were normalised dwell time [%] and fixation frequency [count/s]. Secondary endpoints were blink rate [count/s], maximum pupil size [mm], and rate of pupil change [mm/s].
Results: A total of 20 cases (12 junior, 8 expert) were analysed. Experts showed a prolonged dwell time on the screen during angle of His dissection [91.20% (Range: 83.40-94.40) vs 68.95 % (59.80-87.60); p=0.001], formation of the retrogastric tunnel [91.50% (85.80-95.50) vs 73.60% (34.60–90.50); p=0.001], and gastric pouch formation [86.95% (83.60-90.20) vs 67.60% (37.10–80.00); p<0.001]. Juniors had a greater blink frequency throughout all recorded segments (p<0.01). Juniors had a larger maximum pupil size during all operative segments (p<0.01). Rate of pupil change was greater in juniors in the set-up stage and all analysed operative segments (p<0.01).
Conclusion: These results suggest that experts display more focused attention on significant stimuli. They also experience a reduced mental workload alongside having higher concentration during the procedure. This has the potential for future use in the validation of surgical skill in high stakes assessment.