Gaze and viewing patterns in microsurgery

Gaze disruptions in surgery have been associated with suboptimal surgical workflow, and human factor tools have been developed to quantify these events in cardiovascular and laparoscopic surgeries. Disruptions to workflow may be a particular concern in microsurgery because looking away from the microscope can cause the surgeon to lose view of delicate and precise tasks occurring at the surgical site. However, these viewing patterns in microsurgery have not been investigated. The purpose of this study is to quantify the gaze and viewing patterns during the microsurgery procedure. Event-based task analysis was performed for 14 surgeons performing microsurgery. Results found that average length of procedure was 70±33 minutes. Surgeons were observed to primarily interact with microscope 83±9% during microsurgery. Surgeons were observed to look away from the microscope in order to examine the tool area, patient site, and rest. Frequency of gaze away from the microscope was observed to be 11 disruptions per 10 minutes. Observed gaze demands of microsurgery and the limited opportunity for rests may impact surgeon performance and their risk for musculoskeletal fatigue.