The Application of a System of Eye Tracking in Laparoscopic Surgery: A New Didactic Tool to Visual Instructions

Intraoperative gaze guidance with mixed reality

Efficient communication and collaboration are essential in the operating room for successful and safe surgery. While many technologies are improving various aspects of surgery, communication between attending surgeons, residents, and surgical teams is still limited to verbal interactions that are prone to misunderstandings. Novel modes of communication can increase speed and accuracy, and transform operating rooms. A mixed reality (MR) based gaze sharing application on Microsoft HoloLens 2 headset that can help expert surgeons indicate specific regions, communicate with decreased verbal effort, and guide novices throughout an operation is presented. The utility of the application is tested with a user study of endoscopic kidney stone localization completed by urology experts and novice surgeons. Improvement is observed in the NASA task load index surveys (up to 25.23%), in the success rate of the task (6.98% increase in localized stone percentage), and in gaze analyses (up to 31.99%). The proposed application shows promise in both operating room applications and surgical training tasks.

Utility of an endoscopic image processing system for framing laparoscopic images using surgeon's gaze point and voice commands during laparoscopic percutaneous extraperitoneal closure of inguinal hernia in children

Introduction

In laparoscopic surgery, it is the assistant who manipulates the laparoscope and manages the field of view.

Aim

To develop an endoscopic image processing system that can adjust laparoscopic images as intended by the surgeon without interrupting the surgical procedure.

Material and methods

We developed a touchless user interface that displays a magnified image of the endoscope using information of the surgeon's gaze point acquired by an eye-tracking device and the surgeon's voice commands, and evaluated its usefulness during laparoscopic percutaneous extraperitoneal closure (LPEC) of pediatric inguinal hernia.

Results

LPEC was performed in 15 clinical cases of pediatric inguinal hernia using this system. In all cases, the internal inguinal ring could be ligated by digitally zooming and moving the endoscopic image by eye tracking and voice command while the scope was fixed.

Conclusions

This new touchless user interface with eye tracking shows promise as a support system for laparoscopic surgery.

Improvements of Warning Signs for Black Ice Based on Driving Simulator Experiments

Black ice is one of the main causes of traffic accidents in winter, and warning signs for black ice are generally ineffective because of the lack of credible information. To overcome this limitation, new warning signs for black ice were developed using materials that change color in response to different temperatures. The performance and effects of the new signs were investigated by conducting driver behavior analysis. To this end, driving simulator experiments were conducted with 37 participants for two different rural highway sections, i.e., a curve and a tangent. The analysis results of the driving behavior and visual behavior experiments showed that the conventional signs had insufficient performance in terms of inducing changes in driving behavior for safety. Meanwhile, the new signs actuated by weather conditions offered a statistically significant performance improvement. Typically, driver showed two times higher speed deceleration when they fixed eyes on the new weather-actuated warning sign (12.80 km/h) compared to the conventional old warning sign (6.84 km/h) in the curve segment. Accordingly, this study concluded that the new weather-actuated warning signs for black ice are more effective than the conventional ones for accident reduction during winters.

Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics

Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness' metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants' expertise. The results show that both the mean normalized GSR signal and average surgical instrument's acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.