Looking Together ≠ Seeing the Same Thing: Understanding Surgeons' Visual Needs During Intra-operative Coordination and Instruction

Title of the Paper

Looking Together < Seeing the Same Thing: Understanding Surgeons’ Visual Needs During Intra-operative Coordination and Instruction

Paper Information

• Subject Area: Human-Computer Interaction (HCI), Computer-Supported Cooperative Work (CSCW), Surgical Education
• Keywords: Laparoscopic surgery coordination, visual attention, surgical education, shared gaze visualization, joint visual attention

Research Background and Problem

• What problems or challenges did the authors identify?

  • During surgical procedures, instructors and trainees need to coordinate actions and achieve joint visual attention. Existing instructional methods (such as gestures and verbal explanations) are prone to misinterpretation and fail to accurately convey complex visual information.
  • Visual misalignment during surgery can lead to technical errors, hinder learning, and compromise patient safety.
  • There is limited research on gaze data within surgical environments. Existing technologies show inconsistent results and lack studies on developing trainees' "professional vision."

• Why is this problem important?

  • Aligning visual information during surgery is crucial for ensuring patient safety and improving teaching quality.
  • Current surgical training often suffers from insufficient visual information transmission, which hampers skill development for trainees.
  • The high-risk and high-demand nature of surgical environments makes improving visual guidance particularly critical.

• Research Motivation and Related Work:

  • Shared gaze technology has been shown to enhance collaboration in other contexts (e.g., remote work and education).
  • This study focuses on laparoscopic cholecystectomy, aiming to explore how shared gaze can address challenges in visual coordination and teaching.

Solution

• What methods or solutions did the authors propose?

  • The authors conducted interviews and observational studies to explore the potential use of gaze data during surgery.
  • They proposed leveraging augmented reality (AR) technologies, such as gaze data overviews, depth perception, and image overlays, to support surgical training.

• What are the innovative aspects of the solution?

  • Introduced a novel approach to tailoring visual guidance and feedback based on trainees' skill levels.
  • Highlighted the use of gaze data in teaching tools not only for visual alignment but also for identifying operational challenges to support post-operative reflection and instruction.
  • Used real surgical scenarios (laparoscopic cholecystectomy) to provide practical case studies for the research.

• Implementation Steps:

  • Participant Recruitment: Conducted interviews and observational studies at a university teaching hospital, involving 7 instructors and 7 trainees.
  • Data Collection: Used Tobii Pro Eye Tracking glasses to record gaze data and intra-operative dialogue between instructors and trainees.
  • Thematic Analysis: Observed surgeries and analyzed interview data to summarize visual needs and challenges in surgical collaboration.

Research Outcomes

• What specific outcomes were achieved?

  • Visual Needs and Challenges for Surgical Trainees:
    • Novice trainees struggled to identify anatomical planes and structures in 2D images on the screen.
    • Intermediate and advanced trainees desired greater operational independence but faced pressure from instructors taking over procedures.
    • Trainees at all levels expressed a need for more feedback on their operations and skills.
  • Visual Challenges for Instructors:
    • Instructors found it difficult to determine whether trainees were focusing on the correct anatomical targets.
    • Physical constraints in the surgical environment made verbal and gestural guidance prone to visual misinterpretation.
  • Attitudes Toward Shared Gaze Data:
    • Trainees wanted access to instructors’ real-time gaze behavior for guidance.
    • Instructors viewed gaze data as a teaching tool but not as a comprehensive metric for assessing trainees’ abilities.
    • Both groups supported the use of gaze data for post-operative reflection and feedback.

• What advantages does it offer compared to existing solutions?

  • Proposed visual guidance tailored to trainees’ needs at different learning stages.
  • Emphasized the visualization and replay of gaze data for post-operative teaching and reflection.
  • Went beyond gaze alignment, treating gaze as a signal for analyzing surgical communication and improving learning.

• What were the experimental or evaluation results?

  • Interviews and observations revealed typical scenarios of visual misalignment during surgery and the potential value of gaze-based dialogue.
  • Highlighted the risks of mismatched key visual points and the connection between visual gaps and trainee-instructor interactions.

• Limitations and Future Directions:

  • Limitations:
    • Only observed 8 surgeries, resulting in a small sample size.
    • The study was limited to surgical environments in the U.S., and team dynamics or educational methods may differ in international or low-resource settings.
  • Future Directions:
    • Explore multimodal approaches (including gaze data) combined with surgical scene segmentation techniques to optimize post-operative learning.
    • Design smarter AR-assisted devices to enhance intra-operative teaching.
    • Investigate ethical concerns surrounding gaze data, such as privacy breaches or assessment biases.