TY - JOUR
T1 - Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery
AU - Liao, David
AU - Ishii, Lisa E.
AU - Chen, Lena W.
AU - Chen, Jonlin
AU - Juarez, Michelle
AU - Darrach, Halley M.
AU - Kumar, Anisha R.
AU - Russell, Jonathon O.
AU - Tufano, Ralph P.
AU - Ishii, Masaru
N1 - Publisher Copyright:
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Objective: Measure attentional distraction of neck scars after open neck surgery compared to transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) or transoral endoscopic parathyroidectomy via a vestibular approach (TOEPVA) using eye-tracking technology. Methods: Casual observers viewed facial images of patients who underwent open neck surgery, TOETVA/TOEPVA, or no surgery (controls). An eye-tracking monitor recorded eye fixations in real time. Multivariate Hotelling's analysis followed by post-hypothesis testing compared fixation durations for predefined regions of interest, including the eyes, nose, mouth, neck, and remaining face between open neck surgery patients, transoral neck surgery patients, and controls. Results: One hundred forty observers completed the experiment. The majority of their attention was directed towards the central triangle (eyes, nose, mouth). On multivariate analysis, distribution of attention was significantly different on the faces of those who underwent open neck surgery versus TOETVA/TOEPVA (T2 = 43.66; F[32,131] = 14.5389, P <.0001). Observers attended significantly more to the neck (0.20 seconds, P <.0001; 95% CI, 0.13, 0.26 s) and less to the peripheral face (−0.24 seconds, P =.0031; 95% CI, −0.39, −0.08 s) of open neck surgery patients. In patients who followed up months after surgery, significant differences persisted (T2 = 13.97; F[3451] = 4.6377, P =.0033). By contrast, fixation patterns for TOETVA/TOEPVA patients were not significantly different from controls (T2 = 5.59, F[31,186] = 1.8602, P =.1345). Observer race and gender did not significantly affect attention to neck scars. Conclusion: Scars following open neck surgery draw attention in casual observers. This attentional distraction is prevented in TOETVA/TOEPVA patients due to the absence of a scar, even months after surgery. Moreover, visual processing of TOETVA/TOEPVA patients' faces is similar to that of controls. These data support the effectiveness of transoral neck surgery in giving patients a cosmetic result that does not distract the attention of observers. Level of Evidence: NA Laryngoscope, 130:1603–1608, 2020.
AB - Objective: Measure attentional distraction of neck scars after open neck surgery compared to transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) or transoral endoscopic parathyroidectomy via a vestibular approach (TOEPVA) using eye-tracking technology. Methods: Casual observers viewed facial images of patients who underwent open neck surgery, TOETVA/TOEPVA, or no surgery (controls). An eye-tracking monitor recorded eye fixations in real time. Multivariate Hotelling's analysis followed by post-hypothesis testing compared fixation durations for predefined regions of interest, including the eyes, nose, mouth, neck, and remaining face between open neck surgery patients, transoral neck surgery patients, and controls. Results: One hundred forty observers completed the experiment. The majority of their attention was directed towards the central triangle (eyes, nose, mouth). On multivariate analysis, distribution of attention was significantly different on the faces of those who underwent open neck surgery versus TOETVA/TOEPVA (T2 = 43.66; F[32,131] = 14.5389, P <.0001). Observers attended significantly more to the neck (0.20 seconds, P <.0001; 95% CI, 0.13, 0.26 s) and less to the peripheral face (−0.24 seconds, P =.0031; 95% CI, −0.39, −0.08 s) of open neck surgery patients. In patients who followed up months after surgery, significant differences persisted (T2 = 13.97; F[3451] = 4.6377, P =.0033). By contrast, fixation patterns for TOETVA/TOEPVA patients were not significantly different from controls (T2 = 5.59, F[31,186] = 1.8602, P =.1345). Observer race and gender did not significantly affect attention to neck scars. Conclusion: Scars following open neck surgery draw attention in casual observers. This attentional distraction is prevented in TOETVA/TOEPVA patients due to the absence of a scar, even months after surgery. Moreover, visual processing of TOETVA/TOEPVA patients' faces is similar to that of controls. These data support the effectiveness of transoral neck surgery in giving patients a cosmetic result that does not distract the attention of observers. Level of Evidence: NA Laryngoscope, 130:1603–1608, 2020.
KW - Eye-tracking
KW - TOETVA
KW - endoscopic thyroidectomy
KW - neck scar
KW - transoral neck surgery
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U2 - 10.1002/lary.28305
DO - 10.1002/lary.28305
M3 - Article
C2 - 31660610
AN - SCOPUS:85074834164
SN - 0023-852X
VL - 130
SP - 1603
EP - 1608
JO - Laryngoscope
JF - Laryngoscope
IS - 6
ER -