Insights From Pupil Size to Mental Workload of Surgical Residents: Feasibility of an Educational Computer-Based Surgical Simulation Environment (ECE) Considering the Hand Condition.

The advantage of simulation environments is that they present various insights into real situations, where experimental research opportunities are very limited-for example, in endoscopic surgery. These operations require simultaneous use of both hands. For this reason, surgical residents need to develop several motor skills, such as eye-hand coordination and left-right hand coordination. While performing these tasks, the hand condition (dominant, nondominant, both hands) creates different degrees of mental workload, which can be assessed through mental physiological measures-namely, pupil size. Studies show that pupil size grows in direct proportion to mental workload. However, in the literature, there are very limited studies exploring this workload through the pupil sizes of the surgical residents under different hand conditions. Therefore, in this study, we present a computer-based simulation of a surgical task using eye-tracking technology to better understand the influence of the hand condition on the performance of skill-based surgical tasks in a computer-based simulated environment. The results show that under the both-hand condition, the pupil size of the surgical residents is larger than the one under the dominant and nondominant hand conditions. This indicates that when the computer-simulated surgical task is performed with both hands, it is considered more difficult than in the dominant and nondominant hand conditions. In conclusion, this study shows that pupil size measurements are sufficiently feasible to estimate the mental workload of the participants while performing surgical tasks. The results of this study can be used as a guide by instructional system designers of skill-based training programs.