Surgeons' perceptions of artificial intelligence (AI) for gaze guidance in laparoscopic cholecystectomy

Artificial intelligence (AI) tools offer new opportunities to support human perception and provide gaze guidance in surgery. However, there remains a need to better understand surgeons' perceptions of these tools and to identify desired features across levels of expertise. This study explored surgeons' perceptions of AI-based gaze guidance to determine how such tools can best meet surgeons' needs while recognizing their limitations.

Seventy-one surgeons (38 attendings, 33 residents) watched laparoscopic cholecystectomy videos and responded to open-ended questions about their perceptions of AI for gaze guidance in surgery. Responses were analyzed using latent content analysis to identify themes and desired AI features. Each response was also categorized as positive, negative, or neutral to assess overall perception.

Attendings (92%) and residents (82%) were positive about AI for visual gaze guidance. Neutral responses (9.8%) reflected uncertainty or limited familiarity with AI. Desired features included directing attention, identification, highlighting and visualization, feedback, decision support, educational tools, communication and collaboration, and planning and mapping. Identification involved AI support for recognizing critical structures, abnormalities, gaps in attention, and spatial orientation. Attendings favored AI for decision support and feedback, while residents emphasized its value for visualization and education. Surgeons frequently described AI as a "second pair of eyes," providing guidance, visualization, user control, and safety. Design considerations were also identified to provide guidance without being a potential distractor to the surgeon.

Surgeons across expertise levels expressed positive views toward AI support for gaze guidance, emphasizing the need for features that complement human expertise, align with individual training needs, and account for contextual factors such as minimizing distractions and preventing tunnel vision. Identification, direct attention, and decision support were the most desired features. The findings suggest that tailored AI-based tools can play an important role in surgical training and active procedures by supporting harm reduction.