Eye gaze of endoscopists during simulated colonoscopy

  • Wenjing He
  • Simon Bryns
  • Karen Kroeker
  • Anup Basu
  • Daniel Birch
  • Bin ZhengEmail author
Original Article


Regaining orientation during an endoscopic procedure is critical. We investigated how endoscopists maintain orientation based on video and eye gaze analysis. Novices and experts performed a simulated colonoscopy procedure. Task performance was assessed by completion time, total distance traveled, maximum depth of insertion, percentage of mucosa viewed, and air insufflation volume. Procedure videos were analyzed by transfers among three viewing areas: center of bowel lumen, edge of bowel lumen, and other structure without bowel lumen in sight. Performers’ gaze features were also examined over these viewing areas. Experts required less time to complete the procedure (P < 0.001). Novices’ scope traveled a greater distance (P < 0.001) and more scope was inserted compared to an expert (P < 0.001). Novices also insufflated more air than experts (P < 0.001). Experts maintained the view of bowel lumen in the middle of the screen, while novices often left it on the edge (P = 0.032). When disorientation happened, novices brought the view to the edge more frequently than the center. However, experts were able to bring it back to the center directly. Eye tracking showed that the rate of saccades in experts increased when the bowel lumen moved away from the central view, such a behavior was not observed in novices. Maintaining a centered view of the bowel lumen is a strategy used by expert endoscopists. Video and eye tracking analysis revealed a key difference in eye gaze behavior when regaining orientation between novice and experienced endoscopists.


Endoscopy Eye Movements Training Orientation Competence 



We thank all the students and gastroenterologists for participating in this study.

Compliance with ethical standards

Conflict of interest

Dr. Wenjing He, Simon Bryns, Karen Kroeker, Bin Zheng have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Surgical Simulation Research Lab, Department of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  2. 2.2-40 Zeidler Ledcor Centre, Division of Gastroenterology, Department of MedicineUniversity of AlbertaEdmontonCanada
  3. 3.Department of Computing ScienceUniversity of AlbertaEdmontonCanada
  4. 4.Department of Surgery, Centre for the Advancement of Minimally Invasive Surgery (CAMIS)University of AlbertaEdmontonCanada

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