Recording eye motions in surgical environments is challenging. This study describes the authors' experiences with performing eye-tracking for improving surgery training, both in the laboratory and in the operating room (OR). Three different eye-trackers were used, each with different capabilities and requirements. For monitoring eye gaze shifts over the room scene in a simulated OR, a head-mounted system was used. The number of surgeons' eye glances on the monitor displaying patient vital signs was successfully captured by this system. The resolution of the head-mounted eye-tracker was not sufficient to obtain the gaze coordinates in detail on the surgical display monitor. The authors then selected a high-resolution eye-tracker built in to a 17-inch computer monitor that is capable of recording gaze differences with resolution of 1° of visual angle. This system enables one to investigate surgeons' eye-hand coordination on the surgical monitor in the laboratory environment. However, the limited effective tracking distance restricts the use of this system in the dynamic environment in the real OR. Another eye-tracker system was found with equally high level of resolution but with more flexibility on the tracking distance, as the eye-tracker camera was detached from the monitor. With this system, the surgeon's gaze during 11 laparoscopic procedures in the OR was recorded successfully. There were many logistical challenges with unobtrusively integrating the eye-tracking equipment into the regular OR workflow and data processing issues in the form of image compatibility and data validation. The experiences and solutions to these challenges are discussed.
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