The quiet eye phenomenon in minimally invasive surgery.

Purpose: The quiet eye (QE) behavior is a gaze behavior that has been extensively studied in sports training and has been associated with higher level of expertise in multiple sports. In this paper, we report our observations of this gaze behavior in two minimally invasive surgery settings and we report how this behavior changes based on task success and the surgeon's expertise level.

Methods: We investigated the QE behavior in two independently collected data sets in a sinus surgery setting and a robotic surgery setting. The sinus surgery data set was used to study how the QE behavior changes in successful and unsuccessful tasks. The robotic surgery data set was used to study how the QE behavior changes based on the surgeon's expertise level.

Results: Using the sinus surgery data set, our results show that the QE behavior is more likely to occur and that its duration is significantly longer, in successful tasks, compared with unsuccessful ones. Using the robotic surgery data set, our results show similar trends in tasks performed by experienced surgeons, compared with less experienced ones.

Conclusion: The results of our study open the door to use the QE behavior in training and skill assessment in the explored minimally invasive surgery settings. Training novices to adopt the QE behavior can potentially improve their motor skill learning, replicating the success of doing so in sports training. In addition, the well-defined characteristics of the QE behavior can provide an explainable way to distinguish between different skill levels in minimally invasive surgery.