Division of Neurosurgery, University of Alberta, Edmonton, Canada.
Surgical Simulation Research Lab, University of Alberta, Edmonton, Canada.
World Neurosurg. 2022 Oct;166:e469-e474. doi: 10.1016/j.wneu.2022.07.035. Epub 2022 Jul 14.
Frequent intermittent bleeding control and suction are often necessary during microneurosurgical procedures. We compared the visual searching strategy that guides these types of gross hand movements between expert surgeons and neurosurgical residents.
A total of 70 trials of a microsurgical task consisting of moving a cotton ball with bipolar forceps and a suction instrument under the microscope were recorded. Based on surgical videos, we extracted total task time, boarding time, gaze-tool time gap, number of fixations during the boarding time, and target-locked fixation duration. A comparison of these measures between experts and resident surgeons were performed.
No significant difference was found for total task time, boarding time, and number of fixations during the boarding time between the 2 groups of surgeons. However, we found significant differences in the measure of gaze-tool time gap (P < 0.001, partial η = 0.54) and the target-locked fixation (P < 0.001, partial η = 0.24). Specifically, expert microsurgeons' eyes move to the target board earlier before their tools in hands move (1.01 ± 0.30 seconds) compared with resident microsurgeons (0.44 ± 0.17 seconds). The target-locked fixation duration was also longer among experts comparing to residents (experts: 1.16 ± 0.82 seconds, residents: 0.40 ± 0.30 seconds).
Task time analysis for this basic microsurgical task is not sufficient to evaluate participants' level of expertise. Gaze behavior analysis helps to reveal hidden differences between experts and residents. This research provides more evidence that supports the use of gaze analysis for assessing surgeons' skills in microsurgery.
在神经显微外科手术中，经常需要频繁间歇性地进行出血控制和抽吸。我们比较了专家外科医生和神经外科住院医师在指导这些大体手部运动时的视觉搜索策略。
记录了总共 70 次使用双极镊子和吸引器在显微镜下移动棉球的显微外科任务试验。根据手术视频，我们提取了总任务时间、登机时间、注视-工具时间间隔、登机时间期间的注视次数和目标锁定注视持续时间。对专家和住院医师这两组医生的这些措施进行了比较。
两组外科医生之间的总任务时间、登机时间和登机时间期间的注视次数没有显著差异。然而，我们发现注视-工具时间间隔（P < 0.001，偏 η = 0.54）和目标锁定注视（P < 0.001，偏 η = 0.24）的测量值存在显著差异。具体来说，与住院医师相比，专家显微外科医生的眼睛在工具移动之前更早地移动到目标板（1.01 ± 0.30 秒）（0.44 ± 0.17 秒）。与住院医师相比，专家的目标锁定注视持续时间也更长（专家：1.16 ± 0.82 秒，住院医师：0.40 ± 0.30 秒）。
对于这个基本的显微外科任务，任务时间分析不足以评估参与者的专业水平。注视行为分析有助于揭示专家和住院医师之间的隐藏差异。这项研究提供了更多证据支持使用注视分析来评估外科医生在显微外科手术中的技能。
