Developing expert gaze pattern in laparoscopic surgery requires more than behavioral training

  • Sicong Liu Duke University School of Medicine
  • Rachel Donaldson
  • Ashwin Subramaniam
  • Hannah Palmer
  • Cosette D. Champion
  • Morgan L. Cox
  • L. Gregory Appelbaum
Keywords: Fundamentals of laparoscopic surgery, eye tracking, gaze, area of interest, attention, learning, expertise


Expertise in laparoscopic surgery is realized through both manual dexterity and efficient eye movement patterns, creating opportunities to use gaze information in the educational process. To better understand how expert gaze behaviors are acquired through deliberate practice of technical skills, three surgeons were assessed and five novices were trained and assessed 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). Trained 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, Cohen’s ds > 2). This study demonstrates that, while novices can train to match surgeons on behavioral performance, their gaze pattern is still less efficient than that of surgeons, motivating surgical training programs to involve eye tracking technology in their design and evaluation.

How to Cite
Liu, S., Donaldson, R., Subramaniam, A., Palmer, H., Champion, C. D., Cox, M. L., & Appelbaum, L. G. (2021). Developing expert gaze pattern in laparoscopic surgery requires more than behavioral training. Journal of Eye Movement Research, 14(2).