Eye Tracking and Motion Data Predict Endoscopic Sinus Surgery Skill

Alexandra J. Berges, S. Swaroop Vedula, Alejandro Chara, Gregory D. Hager, Masaru Ishii, Anand Malpani

Research output: Contribution to journalArticlepeer-review


Objective: Endoscopic surgery has a considerable learning curve due to dissociation of the visual-motor axes, coupled with decreased tactile feedback and mobility. In particular, endoscopic sinus surgery (ESS) lacks objective skill assessment metrics to provide specific feedback to trainees. This study aims to identify summary metrics from eye tracking, endoscope motion, and tool motion to objectively assess surgeons' ESS skill. Methods: In this cross-sectional study, expert and novice surgeons performed ESS tasks of inserting an endoscope and tool into a cadaveric nose, touching an anatomical landmark, and withdrawing the endoscope and tool out of the nose. Tool and endoscope motion were collected using an electromagnetic tracker, and eye gaze was tracked using an infrared camera. Three expert surgeons provided binary assessments of low/high skill. 20 summary statistics were calculated for eye, tool, and endoscope motion and used in logistic regression models to predict surgical skill. Results: 14 metrics (10 eye gaze, 2 tool motion, and 2 endoscope motion) were significantly different between surgeons with low and high skill. Models to predict skill for 6/9 ESS tasks had an AUC >0.95. A combined model of all tasks (AUC 0.95, PPV 0.93, NPV 0.89) included metrics from eye tracking data and endoscope motion, indicating that these metrics are transferable across tasks. Conclusions: Eye gaze, endoscope, and tool motion data can provide an objective and accurate measurement of ESS surgical performance. Incorporation of these algorithmic techniques intraoperatively could allow for automated skill assessment for trainees learning endoscopic surgery. Level of Evidence: N/A Laryngoscope, 133:500–505, 2023.

Original languageEnglish (US)
Pages (from-to)500-505
Number of pages6
Issue number3
StatePublished - Mar 2023


  • endoscopic sinus surgery
  • eye movement events
  • eye tracking
  • surgical skill assessment
  • surgical training

ASJC Scopus subject areas

  • Otorhinolaryngology


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