• Jonathan Chainey, Cian J O'Kelly, Yao Zhang, Michael J Kim, and Bin Zheng.
• Division of Neurosurgery, University of Alberta, Edmonton, Canada.
• World Neurosurg. 2022 Oct 1; 166: e469e474e469-e474.

BackgroundFrequent 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.MethodsA 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.ResultsNo 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 η2 = 0.54) and the target-locked fixation (P < 0.001, partial η2 = 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).ConclusionsTask 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.Copyright © 2022 Elsevier Inc. All rights reserved.

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