Cox, M. L. | bioRxiv Science

bioRxiv2020

Skill acquisition and gaze behavior during laparoscopic surgical simulation

BackgroundExperts consistently exhibit more efficient gaze behaviors than non-experts during motor tasks. In surgery, experts have been shown to gaze more at surgical targets than surgical tools during simple simulations and when watching surgical recordings, suggesting a proactive control strategy with greater use of feedforward visual sampling. To investigate such expert gaze behaviors in a more dynamic and complex laparoscopic surgery simulation, the current study measured and compared gaze patterns between surgeons and novices who practiced extensively with laparoscopic simulation. MethodsThree surgeons were assessed in a testing visit and five novices were trained and assessed (at pre-, mid-, and post-training points) in a 5-visit protocol on the Fundamentals of Laparoscopic Surgery peg transfer task. The task was adjusted to have a fixed action sequence to allow recordings of dwell durations based on pre-defined areas of interest (AOIs). Novices individualized learning curves were analyzed using an inverse function model, and group-level differences were tested using analysis of variance on both behavioral performance and dwell duration measures. ResultsTrained novices were shown to reach more than 98% (M = 98.62%, SD = 1.06%) of their behavioral learning plateaus, leading to equivalent behavioral performance to that of surgeons. Despite this equivalence in behavioral performance, surgeons continued to show significantly shorter dwell durations at visual targets of current actions and longer dwell durations at future steps in the action sequence than trained novices (ps [≤] .03, Cohens ds > 2). ConclusionThis study demonstrates that, whereas novices can train to match surgeons on behavioral performance, their gaze pattern is still less efficient than that of surgeons, suggesting that eye-tracking metrics might be more sensitive than behavioral performance in detecting surgical expertise. Such insight can be applied to develop training protocols so non-experts can internalize experts "gaze templates" to accelerate learning. Article SummaryGaze pattern differences persist between laparoscopic surgery experts and novices who have been trained to reach over 98% of individualized behavioral learning plateaus in the Fundamentals of Laparoscopic Surgery (FLS) peg transfer task. The importance of this finding lies in motivating the decision and method of including gaze behaviors via eyetracking technology in the present surgical training programs.

neuroscience↗

bioRxiv2018

Utilizing Transcranial Direct Current Stimulation to Enhance Laparoscopic Technical Skills Training: A Randomized Controlled Trial

This study aimed to test the efficacy of transcranial direct current stimulation (tDCS) during laparoscopic skill training to determine if it has the capacity to accelerate technical skill acquisition. tDCS is a non-invasive brain stimulation technique that delivers constant, low electrical current resulting in changes to cortical excitability and prior work suggests it may enhance motor learning. We evaluate for the first time the potential of tDCS, coupled with motor skill training, to accelerate the development of laparoscopic technical skills. In this pre-registered, double-blinded and sham-controlled study, 60 healthy subjects were randomized into sham or active tDCS in either bilateral primary motor cortex (bM1) or supplementary motor area (SMA) electrode configurations. All subjects practiced the Fundamental of Laparoscopic Surgery Peg Transfer Task during a pre-test, six 20-minute training sessions, and a post-test. The primary outcome was change in laparoscopic skill performance over time, quantified by improvement in performance according to a seconds-per-object calculated score accounting for errors. Sixty participants were randomized equally into the three training cohorts (active bM1, active SMA, sham). The active groups had significantly greater improvement in performance from pre-test to post-test compared to the sham groups (108 vs 76 seconds, p = 0.018). Both bM1 and SMA active cohorts had significantly greater improvement in learning (p < 0.01), achieving the same skill level in 4 sessions compared to the 6 sessions required of the sham cohort. The SMA cohort had more variability in performance compared to the bM1 and control cohorts. Laparoscopic skill training with active, bM1 or SMA, tDCS exhibited significantly greater learning relative to training with sham tDCS. The potential for tDCS to enhance the training of surgical skills merits further investigation to determine if these preliminary results may be replicated.

clinical trials↗