Influence of Surgical Expertise on Visual Gaze Patterns While Viewing a Robotic Adrenalectomy

Objective: This study aimed to quantify and further understand differences in visual perception between surgical expertise and specific procedural events while watching a robotic adrenalectomy. Design: For this cross-sectional observational study, participants viewed a video of a robotic right adrenalectomy and were asked to identify the case afterward. Participants viewed the video under identical conditions without contextual information to minimize perceptual bias. Surgeons were categorized into early career and senior groups based on years of experience. Eye-tracking data was collected using a screen-based eye tracking system (Tobii Pro Fusion) and metrics were extracted for comparison between groups and across procedural steps. Areas of interest (AOIs) were defined as regions where instruments contacted tissue to determine average fixation duration and count. Setting: The study was conducted at the 2024 Society of American Gastrointestinal and Endoscopic Surgeons Meeting. Participants: Fifteen surgeons (5 senior, 10 early career) were recruited from conference attendees. Selection was based on willingness to participate and provision of informed consent. Results: Gaze patterns varied across procedural steps, influenced by AOI complexity and surgical expertise. Significant differences in average fixation duration (p = 0.022) and count (p < 0.001) across AOIs indicate that fixation varied by procedural step. Early career surgeons demonstrated significantly higher fixation duration on the surgical instrument during clearing tissue behind the adrenal vein (p = 0.031), continued dissection next to the IVC (p = 0.017), and ultrasonic medial dissection (p = 0.049) compared to senior surgeons. Senior surgeons demonstrated a more distributed gaze pattern across steps. Conclusions: Senior surgeons demonstrated broader fixation patterns, while residents focused more narrowly on the instrument. This suggests that experienced surgeons have a greater contextual visual understanding of the procedure to shift their attention between instruments and peripheral structures. The integration of eye-tracking into surgical education can help train the gaze patterns of novice learners to improve procedural understanding and perception.