# Enhancing laparoscopic simulator performance with eye-tracking video feedback: a mixed-methods pilot study

## TL;DR

This pilot study explores whether adding eye-tracking feedback to laparoscopic training improves performance and learning experience.

## Contribution

The study introduces eye-tracking with video feedback in laparoscopic training and evaluates its impact on performance and training experience.

## Key findings

- The experimental group showed more focused gaze patterns compared to the control group.
- Residents found tasks more challenging than expected despite prior experience.
- Eye-tracking feedback was perceived as valuable when combined with expert mentorship.

## Abstract

The utility of eye-tracking combined with video-feedback to enhance laparoscopic simulator training remains unexplored. This mixed-methods pilot study aimed to evaluate whether visualising gaze patterns during video feedback improves simulator performance and training experience.

Ten surgical residents were randomised into an experimental group (receiving gaze-overlay video feedback) or a control group (standard video feedback). Participants performed standardised tasks in the Simball Box simulator. Quantitative performance metrics (time, error rates) and eye-tracking data (gaze patterns via Tobii Pro) were analysed. Qualitative data were collected through pre- and post-questionnaires and a subsequent group interview to assess the perceived value of the training.

Although 90% of residents had prior experience, the majority (60%) found the specific tasks more challenging than anticipated. Subjective ratings of feedback value did not differ significantly between groups. However, objective heat map analysis revealed that the experimental group adopted significantly more focused gaze patterns. Qualitative interviews underscored that while technological feedback is valuable, it is most effective when paired with expert mentorship.

This pilot study suggests that eye-tracking feedback may facilitate more efficient visual strategies during laparoscopic training. While the experimental group demonstrated initial performance gains, larger cohorts are needed to statistically validate these findings. The study further emphasises that for simulation technology to be meaningful, it must be integrated into a structured curriculum with expert guidance.