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Eye gaze of endoscopists during simulated colonoscopy

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

Abstract

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.

Keywords

Endoscopy Eye Movements Training Orientation Competence 

Notes

Acknowledgements

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.

References

  1. 1.
    Varadarajulu S, Banerjee S, Barth BA, Desilets DJ, Kaul V, Kethu SR, Pedrosa MC, Pfau PR, Tokar JL, Wang A, Wong Kee Song LM, Rodriguez SA (2011) GI endoscopes. Gastrointest Endosc 74(1–6):e6Google Scholar
  2. 2.
    Ekkelenkamp VE, Koch AD, de Man RA, Kuipers EJ (2016) Training and competence assessment in GI endoscopy: a systematic review. Gut 65:607–615CrossRefGoogle Scholar
  3. 3.
    Allen JI (2012) Quality assurance for gastrointestinal endoscopy. Curr Opin Gastroenterol 28:442–450CrossRefGoogle Scholar
  4. 4.
    Moore LE (2003) The advantages and disadvantages of endoscopy. Clin Tech Small Anim Pract 18:250–253CrossRefGoogle Scholar
  5. 5.
    Cao CGL, Milgram P (2000) Disorientation in minimal access surgery: a case study. HFES Ann Meet Proc 44:169–172CrossRefGoogle Scholar
  6. 6.
    Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C (2007) Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 21:994–997CrossRefGoogle Scholar
  7. 7.
    Rabeneck L, Paszat LF, Hilsden RJ et al (2008) Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 135:1899–1906 (e1891) CrossRefGoogle Scholar
  8. 8.
    van Dongen KW, Tournoij E, van der Zee DC, Schijven MP, Broeders IAMJ (2007) Construct validity of the LapSim: can the LapSim virtual reality simulator distinguish between novices and experts? Surg Endosc 21:1413–1417CrossRefGoogle Scholar
  9. 9.
    Triantafyllou K, Lazaridis LD, Dimitriadis GD (2014) Virtual reality simulators for gastrointestinal endoscopy training. World J Gastrointest Endosc 6:6–12CrossRefGoogle Scholar
  10. 10.
    Seymour NE, Gallagher Anthony G, Roman Sanziana A et al (2002) Virtual Reality training improves operating room performance: results of a randomized, double-blinded Study. Ann Surg 236:458–464CrossRefGoogle Scholar
  11. 11.
    Ahlberg G, Hultcrantz R, Jaramillo E, Lindblom A, Arvidsson D (2005) Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist? Endoscopy 37:1198–1204CrossRefGoogle Scholar
  12. 12.
    Meining A, Atasoy S, Chung A, Navab N, Yang GZ (2010) “Eye-tracking” for assessment of image perception in gastrointestinal endoscopy with narrow-band imaging compared with white-light endoscopy. Endoscopy 42:652–655CrossRefGoogle Scholar
  13. 13.
    Dik VK, Hooge IT, van Oijen MG, Siersema PD (2016) Measuring gaze patterns during colonoscopy: a useful tool to evaluate colon inspection? Eur J Gastroenterol Hepatol 28:1400–1406CrossRefGoogle Scholar
  14. 14.
    Habaz I et al. (2019) Adaptation of the fundamentals of laparoscopic surgery box for endoscopic simulation: performance evaluation of the first 100 participants. Surg Endosc.  https://doi.org/10.1007/s00464-018-06617-6 Google Scholar
  15. 15.
    Bar-Meir S (2000) A new endoscopic simulator. Endoscopy 32:898–900CrossRefGoogle Scholar
  16. 16.
    Dunkin B, Adrales GL, Apelgren K, Mellinger JD (2007) Surgical simulation: a current review. Surg Endosc 21:357–366CrossRefGoogle Scholar
  17. 17.
    Britannica E (1987) Sensory reception: human vision: structure and function of the human eye. Google Scholar, Encyclopedia BritannicaGoogle Scholar
  18. 18.
    Benjamin L, Atkins MS, Kirkpatrick AE, Alan JL (2004) Eye gaze patterns differentiate novice and experts in a virtual laparoscopic surgery training environment. In: Proceedings of the 2004 symposium on Eye tracking research and applications, ACM, San Antonio, Texas, pp 41–48Google Scholar
  19. 19.
    Sonnenberg A (2018) Limitations of teaching endoscopy. Eur J Gastroenterol Hepatol 30:252–256Google Scholar
  20. 20.
    Zanchetti DJ, Schueler SA, Jacobson BC, Lowe RC (2016) Effective teaching of endoscopy: a qualitative study of the perceptions of gastroenterology fellows and attending gastroenterologists. Gastroenterol Rep 4:125–130CrossRefGoogle Scholar

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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