Describing What Surgeons See: Visual Orientation Strategies in Laparoscopic Cholecystectomy Across Imaging Conditions

Area of Science:

• Laparoscopic surgery
• Surgical visualization
• Cognitive science in medicine

Background:

• Visual orientation is crucial for safe and effective laparoscopic surgery.
• Understanding how surgeons orient themselves under different imaging conditions is essential for improving training and technology.

Purpose of the Study:

• To investigate visual orientation strategies of surgeons with varying expertise during laparoscopic cholecystectomy.
• To compare strategies under white light versus indocyanine green (ICG) fluorescence imaging.

Main Methods:

• Cross-sectional observational study involving 71 surgeons (attendings and residents).
• Participants viewed laparoscopic cholecystectomy videos under white light and ICG fluorescence.
• Latent content analysis of open-ended responses on viewing strategies.

Main Results:

• Visual orientation is a dynamic, layered process involving perception and cognition.
• Expertise influences orientation depth and focus.
• Attendings prioritized critical structures (white light), while residents focused on procedural activity and landmarks.
• Both groups heavily relied on fluorescence cues under ICG imaging.

Conclusions:

• Surgical expertise and imaging modality significantly impact visual orientation strategies.
• Attendings adopt a target-focused approach, while residents use salient cues and landmarks.
• Training and visual aids should align with surgeons' cognitive-perceptual strategies to enhance situational awareness.