title: Collaborative eye tracking: a potential training tool in laparoscopic surgery.
abstract: BACKGROUND
  Eye-tracking technology has been shown to improve trainee performance in the aircraft industry, radiology, and surgery. The ability to track the point-of-regard of a supervisor and reflect this onto a subjects' laparoscopic screen to aid instruction of a simulated task is attractive, in particular when considering the multilingual make up of modern surgical teams and the development of collaborative surgical techniques. We tried to develop a bespoke interface to project a supervisors' point-of-regard onto a subjects' laparoscopic screen and to investigate whether using the supervisor's eye-gaze could be used as a tool to aid the identification of a target during a surgical-simulated task.
  
  
  METHODS
  We developed software to project a supervisors' point-of-regard onto a subjects' screen whilst undertaking surgically related laparoscopic tasks. Twenty-eight subjects with varying levels of operative experience and proficiency in English undertook a series of surgically minded laparoscopic tasks. Subjects were instructed with verbal queues (V), a cursor reflecting supervisor's eye-gaze (E), or both (VE). Performance metrics included time to complete tasks, eye-gaze latency, and number of errors.
  
  
  RESULTS
  Completion times and number of errors were significantly reduced when eye-gaze instruction was employed (VE, E). In addition, the time taken for the subject to correctly focus on the target (latency) was significantly reduced.
  
  
  CONCLUSIONS
  We have successfully demonstrated the effectiveness of a novel framework to enable a supervisor eye-gaze to be projected onto a trainee's laparoscopic screen. Furthermore, we have shown that utilizing eye-tracking technology to provide visual instruction improves completion times and reduces errors in a simulated environment. Although this technology requires significant development, the potential applications are wide-ranging.
authors.affiliation: Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College, London, UK. Andrewchetwood@doctors.org.uk
authors.forename: Andrew S A
authors.initials: AS
authors.lastname: Chetwood
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Kwok
authors.forename: Loi-Wah
authors.initials: LW
authors.lastname: Sun
authors.forename: George P
authors.initials: GP
authors.lastname: Mylonas
authors.forename: James
authors.initials: J
authors.lastname: Clark
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
mesh_terms: D000704:Analysis of Variance; D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods*; D004867:Equipment Design; D005133:Eye Movements; D005260:Female; D005403:Fixation, Ocular; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000295:instrumentation; D008297:Male; D012057:Reinforcement, Verbal; D012984:Software; D013664:Teaching Materials