Insights From Pupil Size to Mental Workload of Surgical Residents: Feasibility of an Educational Computer-Based Surgical Simulation Environment (ECE) Considering the Hand Condition

Abstract

The advantage of simulation environments is that they present various insights into real situations, where experimental research opportunities are very limited-for example, in endoscopic surgery. These operations require simultaneous use of both hands. For this reason, surgical residents need to develop several motor skills, such as eye-hand coordination and left-right hand coordination. While performing these tasks, the hand condition (dominant, nondominant, both hands) creates different degrees of mental workload, which can be assessed through mental physiological measures-namely, pupil size. Studies show that pupil size grows in direct proportion to mental workload. However, in the literature, there are very limited studies exploring this workload through the pupil sizes of the surgical residents under different hand conditions. Therefore, in this study, we present a computer-based simulation of a surgical task using eye-tracking technology to better understand the influence of the hand condition on the performance of skill-based surgical tasks in a computer-based simulated environment. The results show that under the both-hand condition, the pupil size of the surgical residents is larger than the one under the dominant and nondominant hand conditions. This indicates that when the computer-simulated surgical task is performed with both hands, it is considered more difficult than in the dominant and nondominant hand conditions. In conclusion, this study shows that pupil size measurements are sufficiently feasible to estimate the mental workload of the participants while performing surgical tasks. The results of this study can be used as a guide by instructional system designers of skill-based training programs.

Mobile pupillometry in manual assembly: A pilot study exploring the wearability and external validity of a renowned mental workload lab measure

“…In all, our results could not replicate seminal laboratory work on pupillometry (cf., Beatty & Kahneman, 1966;Hess & Polt, 1960;Kahneman et al, 1969; or more recently, Moyes, Sari-sarraf, & Gilbert, 2019) and highlights the challenges in reaching external validity. Research on driving (cf., Recarte & Nunes, 2003), air traffic control (cf., Ahlstrom & Friedman-berg, 2006) and, for instance, piloting (cf., Causse et al, 2016) and surgery performance (cf., Dalveren et al, 2018;Erridge et al, 2017) already made great strides in closing this gap. While being seated and at a predominantly stable distance to experimental the stimuli, pupillometry in these contexts might become robust as soon as, i.a., variations in luminance (Lohani, Payne, & Strayer, 2019) and curvilinear effects can be accounted for.…”

“…(2018) observed a pupil size decrease throughout a LEGO building process, except when the child participants had to back-step. Finally, differences between experts and non-experts in surgical skill have been related to pupil size (Erridge, Ashraf, Purkayastha, Darzi, & Sodergren, 2017;Richstone et al, 2010) and also harder visual-motor aiming tasks (such as with a one-handed grasper in endoscopic surgery) yield higher pupil dilation (Jiang, Zheng, Bednarik, & Atkins, 2015; see also, Dalveren, Cagiltay, Ozcelik, & Maras, 2018).…”

Are left- and right-eye pupil sizes always equal?

“…Other studies also showed the presence of a relation between attention and eye movements Rizzolatti, Riggio, Dascola, & Umiltá, 1987). According to an earlier study in which surgical tasks were performed under different hand conditions (both hands, dominant hand or non-dominant hand), there were changes in the pupil sizes of the surgical residents, indicating that when tasks were performed under the both-hands condition, they were considered more difficult than the dominant and nondominant hand conditions (Menekse Dalveren, Cagiltay, Ozcelik, & Maras, 2018).…”

Combined Gaze Metrics as Stress-Sensitive Indicators of Microsurgical Proficiency

“…In Ref. 20 , the authors used pupil size as a metric for mental workload when comparing bimanual and unimanual performance during a simulated endoscopic task.…”