Pupil size as an indicator of visual-motor workload and expertise in microsurgical training tasks

Bednarik, Roman; Bartczak, Piotr; Vrzáková, Hana; Koskinen, Jani; Elomaa, Antti-Pekka; Huotarinen, Antti; Pérez, David Gil de Gómez; Fraunberg, Mikael von und zu

doi:10.1145/3204493.3204577

Cited by 13 publications

(11 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After developing an eye-tracker that can be embedded into a surgical microscope, 15 researchers started to investigate the topic of eye-hand coordination of neurosurgeons and found different gaze behaviours between expert and novice microsurgeons while performing a microsuturing task. 16,17 In our experiment, the gaze analysis revealed that novices tend to have longer post-jump fixation durations than experts. In other words, when an abrupt movement slip (jump) occurred, the novices took a longer time to adjust their gazes for guiding their movements in hands.…”

Section: Post-jump Fixation Duration (Ms)mentioning

confidence: 51%

Neurosurgical performance between experts and trainees: Evidence from drilling task

Chainey

O’Kelly

Kim³

et al. 2021

Robotics Computer Surgery

View full text Add to dashboard Cite

Background: Lumbar laminectomy is a common neurosurgery that requires precise manipulation of power drills. We examined the fine movement controls of novice neurosurgeons in drilling tasks and compared its accuracy to expert surgeons' performance.Methods: Four experts and three novice neurosurgeons performed a lumbar laminectomy on a three-dimensional printed spine model. Scene video and surgeons' eye movements were recorded. Independent sample t-Tests were conducted on the number of jump, total fixation durations, pre-jump fixation durations, post-jump fixation durations and jump distances over novice and expert surgeons. Results:No statistically significant differences were recorded in terms of total fixations and pre-jump fixation durations. However, novices had more jumping events, greater jump distances and longer post-jump fixation durations when compared to expert neurosurgeons. Conclusion:Differences in movement accuracy and eye measures were found between expert and novice neurosurgeons during a simulated microscopic lumbar laminectomy. A more comprehensive understanding of surgeon's fine movement control mechanism and eye-hand coordination in microsurgery is essential for us before building an enhanced training protocol for surgical residents in neurosurgery. K E Y W O R D Scompetency assessment, drill, eye tracking, microsurgery, surgical training | INTRODUCTIONDecompressive lumbar laminectomy is one of the most common orthopaedic and neurosurgical procedures performed on the spine. It is used to treat spinal stenosis, herniated discs and tumours. 1 In this procedure, the surgeon needs to drill the lamina of the vertebrae using a power tool to gain access to the spinal canal and reduce the pressure on the thecal sac and nerve roots. The power drill often generates a significant amount of mechanical vibrations. Vibrations can be challenging for the surgeon who needs precise and controlled movements to avoid damage to nearby neurological structures.Another factor that can affect the surgeon's movement accuracy is the interaction between the drill bit and the bone. This interaction is influenced by multiple elements such as the angle of contact between the bur and the bone, the speed of the drill and the bone density. Expert surgeons, through experience, have integrated these factors to avoid involuntary movements of the drill.Studies in human movement control have revealed that human fine movements are controlled primarily through visual and haptic pathways. Before our hand gets in contact with an object, our visual system collects information about the target, including distance, shape, weight, texture and so forth. Once our hand makes contact with the object, mechanoreceptors beneath our skin gather information specific to that object, whereas the sensors inside our joints

show abstract

Section: Post-jump Fixation Duration (Ms)mentioning

confidence: 51%

Neurosurgical performance between experts and trainees: Evidence from drilling task

Chainey

O’Kelly

Kim³

et al. 2021

Robotics Computer Surgery

View full text Add to dashboard Cite

show abstract

“…While previous studies in this domain often focused on utilization of eye-tracking to obtain eye-position data and gain insights into cognition and attention, in this work we utilized eye-tracking to collect blink-related signals. This work is the first one to report on the blink-rates during microsurgical procedures, and complements the reports using pupil monitoring during microsurgical training [23]. Our motivation was to uncover the differences between expert and novice microsurgeons and to relate blink-rates to suturing task workload and complexity.…”

Section: Discussionmentioning

confidence: 88%

“…We used a SeeTrue 2 embedded eye-tracker, a model designed as an adapted version of an ocular-mounter eyetracker previously introduced by Eivazi et al [22] and employed e.g. in [23]. The system was attached to the last piece of a microscope ocular, and using a video camera collected the images of the right users' eye.…”

Section: Apparatusmentioning

confidence: 99%

Blink-Based Estimation of Suturing Task Workload and Expertise in Microsurgery

Bednarik¹,

Koskinen²,

Vrzáková³

et al. 2018

2018 IEEE 31st International Symposium on Computer-Based Medical Systems (CBMS)

Self Cite

View full text Add to dashboard Cite

Artikkelit ja abstraktit tieteellisissä konferenssijulkaisuissa © IEEE All rights reservedAbstract-Eye-hand coordination is a central skill in microsurgery. To develop efficacious microsurgical training environments to support development of eye-hand coordination, it is important to understand the workload associated with visuomotor tasks in microsurgery. We embedded an eye-tracker to a surgical microscope and collected eye-blink data of 10 participants during a microsuture training task. Blink-rate was shown to drop to low levels compared to a resting-state rate and be sensitive to the phases of microsurgical suture. We discuss these findings in the light of operator training in microsurgical environments.

show abstract

“…With a custom eye tracker embedded into a surgical microscope, we recorded the blinks and pupil dilations of novice and expert microsurgeons as they performed a set of microsurgical training sutures. In our previous research, 28,29 we found that novices estimated the suturing task to be significantly more demanding than experts and that there are differences in pupil dilations and blink rates between these 2 groups. Here, we extend this research by studying the combined applicability of pupil dilation and blink rate to classify expertise at suture-and segment-level features.…”

Section: Introductionmentioning

confidence: 77%

“…The pupils were detected with a custom Hough transform–based algorithm, as described in Ref. 28 . Traditional blink detection methods did not deliver satisfying results due to the custom-made setup of the eye tracker, and thus, we opted to filtering the blinks out manually.…”

Section: Methodsmentioning

confidence: 99%

Combined Gaze Metrics as Stress-Sensitive Indicators of Microsurgical Proficiency

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background. Evaluation of microsurgical proficiency is conventionally subjective, time consuming, and unreliable. Eye movement–based metrics have been promising not only in detection of surgical expertise but also in identifying actual cognitive stress and workload. We investigated if pupil dilations and blinks could be utilized in parallel to accurately classify microsurgical proficiency and its moderating features, especially task-related stress. Methods. Participants (n = 11) were divided into groups based on prior experience in microsurgery: novices (n = 6) with no experience and trained microsurgeons (n = 5). All participants conducted standardized suturing tasks with authentic instruments and a surgical microscope. A support vector machine classifier was used to classify features of microsurgical expertise based on percentage changes in pupil size. Results. A total of 109 successful sutures with 1090 segments were recorded. Classification of expertise from sutures achieved accuracies between 74.3% and 76.0%. Classification from individual segments based on these same features was not feasible. Conclusions. Combined gaze metrics are applicable for classifying surgical proficiency during a defined task. Pupil dilation is also sensitive to external stress factors; however, the usefulness of blinks is impaired by low blink rates. The results can be translated to surgical education to improve feedback and should be investigated individually in the context of actual performance and in real patient operations. Combined gaze metrics may be ultimately utilized to help microsurgeons monitor their performance and workload in real time—which may lead to prevention of errors.

show abstract

Pupil size as an indicator of visual-motor workload and expertise in microsurgical training tasks

Cited by 13 publications

References 17 publications

Neurosurgical performance between experts and trainees: Evidence from drilling task

Neurosurgical performance between experts and trainees: Evidence from drilling task

Blink-Based Estimation of Suturing Task Workload and Expertise in Microsurgery

Combined Gaze Metrics as Stress-Sensitive Indicators of Microsurgical Proficiency

Contact Info

Product

Resources

About