Objectively measuring social attention of thyroid neck scars and transoral surgery using eye tracking

Abstract

Objective Measure the social attention of thyroid neck scars and transoral surgery using eye tracking. Methods Observers viewed images of patients with thyroid neck scars, control patients with no scars, and patients who underwent transoral thyroidectomy as an eye‐tracking monitor recorded their eye movements. Hotelling's multivariate analysis, followed by planned posthypothesis testing, were used to compare fixation times for the central triangle (CT), peripheral face, and neck between the three groups. To assess if these gaze patterns would normalize with transoral surgery, a two‐sample t test was done to assess for differences in neck fixations between control and transoral patients and between transoral and traditional thyroidectomy. Results One hundred and thirty participants completed the eye‐tracking experiment (mean age 24.3 years, 65 females). Observers directed the majority of their attention to the CT in both control and scar patients. Observers paid more attention to the neck (103.72 ms, P < .0001, 95% confidence interval [CI] [55, 152] ms) and less to the peripheral face (115.50 ms, P = .01, 95% CI [19, 211] ms) in patients with neck scars than in control patients. Furthermore, transoral surgery eliminated this attentional distraction wherein there was no difference in the fixation time to the neck (−39.198 ms P = .16, 95% CI [−93.978, 15.5816] ms) between controls and those who underwent transoral surgery. Conclusion Observers directed their gaze away from the face and toward the neck in patients with thyroid neck scars. Furthermore, this distraction was eliminated with tranoral surgery. These findings shed light onto the altered observer perceptions of patients with thyroid neck scars. Level of Evidence NA Laryngoscope, 129:2789–2794, 2019

Safety and efficacy of transoral robotic and endoscopic thyroidectomy: The first 100 cases

“…Neck scarring, a major concern after thyroidectomy, is related to quality of life, irrespective of the severity and length of the scar . Therefore, it is reasonable to avoid a visible neck scar if it can be done safely and effectively.…”

Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery

“…Casual observers in their study spent significantly more time looking at the necks of open thyroidectomy patients and less time on the peripheral face (the area outside of the central triangle of the eyes, nose, and mouth). 12 The current study builds on this pilot and earlier literature by exploring whether TOETVA/TOEPVA can prevent the attentional distraction caused by a neck scar following open surgery. We utilized a series of 60 patient photos of various racial identities.…”

“…Previous pilot work using eye-tracking technology has shown that open thyroidectomy scars cause attentional bias to the neck compared to transoral thyroidectomy in a handful of patients, suggesting that neck scars are proximal and noticeable enough to alter the conserved visual processing patterns of human faces. 12 The current study builds upon earlier work by employing eye-tracking methodology to look at a large cohort of patients who either underwent open neck surgery (thyroidectomy, parathyroidectomy, or thyroidectomy with concomitant neck dissection) or their transoral endoscopic counterparts (TOETVA or transoral endoscopic parathyroidectomy via a vestibular approach [TOEPVA]). This group of patients included those who presented at various times for follow-up (ie, weeks to months) and were of different racial identities.…”

Transoral robotic thyroidectomy on two human cadavers using the Intuitive da Vinci single port robotic surgical system and CO2 insufflation: Preclinical feasibility study

“…Some patients find this troubling and seek other options to minimize the scar. [2][3][4][5] Richmon et al in a cadaver, 6,7 demonstrated the feasibility of a transoral vestibular technique. It was brought to clinical practice in 2014 8 with the endoscopic approach and was reported to be safe and effective in a larger series of patients in 2016.…”

“…Although it has been the standard approach for more than 100 years, it does leave a permanent cervical scar that may heal in a variable fashion. Some patients find this troubling and seek other options to minimize the scar …”