Visual behaviour in robotic surgery-Demonstrating the validity of the simulated environment

Background Eye metrics provide insight into surgical behaviour allowing differentiation of performance, however have not been used in robotic surgery. This study explores eye metrics of robotic surgeons in training in simulated and real tissue environments. Methods Following the Fundamentals of Robotic Surgery (FRS), training curriculum novice robotic surgeons were trained to expert-derived benchmark proficiency using real tissue on the da Vinci Si and the da Vinci skills simulator (dVSS) simulator. Surgeons eye metrics were recorded using eye-tracking glasses when both novice and proficient in both environments. Performance was assessed using Global Evaluative Assessment of Robotic skills (GEARS) and numeric psychomotor test score (NPMTS) scores. Results Significant (P <= .05) correlations were seen between pupil size, rate of change and entropy, and associated GEARS/NPMTS in novice and proficient surgeons. Only number of blinks per minute was significantly different between pupilometrics in the simulated and real tissue environments. Conclusions This study illustrates the value of eye tracking as an objective physiological tool in the robotic setting. Pupilometrics significantly correlate with established assessment methods and could be incorporated into robotic surgery assessments.