Related Experiment Video
Updated: May 7, 2026
Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
Published on: November 25, 2025
Describing What Surgeons See: Visual Orientation Strategies in Laparoscopic Cholecystectomy Across Imaging Conditions
Taylor Quinn1, Elena Lopez2, Joseph C L'Huillier3
1Department of Industrial & Systems Engineering, University at Buffalo, Buffalo, New York.
Objective:
This study examines how surgeons across different expertise levels describe their visual orientation strategies under white light and fluorescence imaging using indocyanine green (ICG) dye in laparoscopic cholecystectomy.
Design:
In this cross-sectional observational study, participants viewed a series of laparoscopic cholecystectomy video clips under white light and fluorescence imaging with ICG dye. Participants then responded to open-ended questions regarding their viewing strategies. Responses were analyzed using latent content analysis to identify visual orientation primary and subthemes.
Setting:
The study was conducted at the 2025 Society of American Gastrointestinal and Endoscopic Surgeons Meeting.
Participants:
Seventy-one surgeons (38 attendings, 33 residents) participated in this study and were recruited from conference attendees. All participant completed the study procedures.
Results:
Visual orientation was identified as a layered, dynamic process incorporating perceptual and cognitive elements. Expertise influenced the depth and focus of orientation strategies. In white light, attendings prioritized identifying critical structures (26.3%). The top subthemes included establishing spatial orientation (17.9%), focusing on the surgical target (17.9%), and assessing strategy (17.9%). Residents focused on procedural activity (27.3%), with subthemes of establishing spatial orientation (39.1%), peripheral scanning (21.7%), and identifying anatomical landmarks (13%). Under fluorescence, both attendings (56.8%) and residents (71.9%) emphasized fluorescence cues.
Conclusion:
Visual orientation strategies varied across levels of expertise and imaging condition. Attendings demonstrated a more target-focused approach to identify critical structures, while residents relied on salient cues and peripheral landmarks. Findings reveal the need for surgical training and visual support tools aligned with surgeons' perceptual-cognitive strategies to improve situation awareness and prioritization of visual cues.
