J A Ibbotson | PubMed Health

PubMed1999

Gaze patterns in laparoscopic surgery.

By understanding surgeons' patterns of gaze, and what visual information is being obtained during a procedure, one can improve the operation via new techniques or instrumentation. Part of a larger project on Remote Manipulation in Endoscopic Surgery, we analyzed eye patterns of surgeons from videotape annotation. Three categories of eye patterns were defined: 1) eyes on (gaze on monitor); 2) eyes down (gaze on external operative space); 3) eyes off (gaze away from monitor/hands). In the context of hierarchical decomposition of procedures we compared eye patterns and sequential dependencies (gaze as a function of previous gaze) by procedure, surgical steps and tasks. Timelines showed transitions in eye patterns during the procedure. We determined what visual information is available and what visual information is needed by the surgeons. By comparing these, we suggest technology that can provide these needs.

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PubMed1999

Hierarchical decomposition of laparoscopic procedures.

The purpose of this report is to outline the hierarchical decomposition of surgical procedures, from surgical steps through tasks and subtasks to tool motions, and highlight implications for surgical training systems. Three common laparoscopic procedures were analysed: cholecystectomy, inguinal hernia repair, and Nissen fundoplication. In laparoscopic training workshops and operating rooms, our observational research included split screen videotaping of both the endoscopic view and our video camera's view of the primary surgeon. Videotapes were extensively annotated and analysed to yield timelines of each procedure, with component surgical steps, substeps, tasks, and subtasks duration as a function of procedure. The hierarchical decomposition of surgical procedures provides a framework for structuring a systematic approach to training, in the real and simulated environment. An example comparing variations in the fundoplication procedure is presented. Our results also have important implications for the design and assessment of new technology and intelligent tools in endoscopic surgery.

Cholecystectomy, Laparoscopic↗