title: The impact of expert visual guidance on trainee visual search strategy, visual attention and motor skills.
abstract: Minimally invasive and robotic surgery changes the capacity for surgical mentors to guide their trainees with the control customary to open surgery. This neuroergonomic study aims to assess a "Collaborative Gaze Channel" (CGC); which detects trainer gaze-behavior and displays the point of regard to the trainee. A randomized crossover study was conducted in which twenty subjects performed a simulated robotic surgical task necessitating collaboration either with verbal (control condition) or visual guidance with CGC (study condition). Trainee occipito-parietal (O-P) cortical function was assessed with optical topography (OT) and gaze-behavior was evaluated using video-oculography. Performance during gaze-assistance was significantly superior [biopsy number: (mean ± SD): control = 5.6 ± 1.8 vs. CGC = 6.6 ± 2.0; p < 0.05] and was associated with significantly lower O-P cortical activity [ΔHbO2 mMol × cm [median (IQR)] control = 2.5 (12.0) vs. CGC 0.63 (11.2), p < 0.001]. A random effect model (REM) confirmed the association between guidance mode and O-P excitation. Network cost and global efficiency were not significantly influenced by guidance mode. A gaze channel enhances performance, modulates visual search, and alleviates the burden in brain centers subserving visual attention and does not induce changes in the trainee's O-P functional network observable with the current OT technique. The results imply that through visual guidance, attentional resources may be liberated, potentially improving the capability of trainees to attend to other safety critical events during the procedure.
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Leff
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK.
authors.forename: David R C
authors.initials: DR
authors.lastname: James
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK ; National Institute for Astrophysics, Optics and Electronics (INAOE) Tonantzintla, Mexico.
authors.forename: Felipe
authors.initials: F
authors.lastname: Orihuela-Espina
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK.
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Kwok
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK.
authors.forename: Loi Wah
authors.initials: LW
authors.lastname: Sun
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK.
authors.forename: George
authors.initials: G
authors.lastname: Mylonas
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK.
authors.forename: Ara W
authors.initials: AW
authors.lastname: Darzi
authors.affiliation: Hamlyn Centre for Robotic Surgery, Imperial College London London, UK.
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
keywords: collaborative gaze; functional near infrared spectroscopy; graph theory; mentoring; neuroergonomics; optical topography; skills assessment; visual attention