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.
Highlights
In high-risk industry, collaboration between operators is integral to performing goal-orientated tasks successfully
The aim of this paper is to investigate the influence of a gaze channel on changes in visual search strategies, technical performance, and brain behavior in a group of task naïve subjects being instructed to perform simulated biopsy using robotic minimally invasive surgery (MIS)
The task was performed under both guidance conditions such that subjects served as their own controls and bias associated with learning or ordering effects was minimized
Summary
In high-risk industry, collaboration between operators is integral to performing goal-orientated tasks successfully (e.g., pilots, airtraffic controller, surgeons, etc). Recent developments in technologies for robotic surgery such as dual console systems (e.g., da Vinci Si) enable two surgeons to operate simultaneously, facilitating both high-level co-operation and mentorship as well as potentially streamlining the operators’ cognitive resources towards improved safety. In this scenario, it is important that communication between both surgeons is effective to enable a seamless flow of information between the two operators and ensure an efficient workflow. During robotic minimally invasive surgery (MIS), there may be circumstances in which the trainee or collaborating surgeon is using both instruments simultaneously within the operative field of view, constraining the trainer/master surgeon and rendering them reliant solely on verbal communication
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