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.

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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, Cohen’s 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.

The perception of visual motion is dependent on a set of occipitotemporal regions which are readily accessible to neuromodulation. Previous studies using paired-pulse Transcranial Magnetic Stimulation (ppTMS) have provided evidence of the capacity of this type of protocols to modulate cognitive processes.To test whether such cortical modulation can be observed in the visual system, particularly during motion perception, ppTMS was applied to the occipital cortex using both scalp-based and meta-analytic targeting coordinates. In this within-subject, sham-controlled study, fifteen subjects completed two sessions in two consecutive weeks. On the first visit, subject-specific resting motor threshold (RMT) was determined and participants performed an adaptive motion discrimination task to determine individual motion sensitivity.During the second visit, subjects performed the same task with three individualized difficulty levels as two TMS pulses were delivered respectively -150 and -50 ms prior to motion stimulus onset at 120%RMT, under the logic that the cumulative inhibitory effect of these two pulses would alter motion sensitivity as measured by the individually calibrated task. The ppTMS was delivered at one of two locations: 3 cm dorsal and 5 cm lateral to inion (scalp-based coordinate), or at the site of peak activation for "motion" according to the NeuroSynth fMRI database (meta-analytic coordinate). Sham stimulation was delivered on one-third of trials and evenly between the two targets. Analyses showed no significant active-versus-sham effects of ppTMS when stimulation was delivered to the meta-analytic (p = 0.15) or scalp-based coordinates (p = 0.17), which were separated by 29 mm on average. Additionally, there was no was significant interaction between ppTMS at either location and task difficulty level (p = 0.12 and p = 0.33, respectively). These findings fail to support the hypothesis that long-interval ppTMS recruits inhibitory processes in motion-sensitive cortex, but must be considered within the limits of the current design choices.