Under the Microscope: Expert Novice Gaze Differences During Suturing ETRA019

Microsurgery requires visuomotor coordination under high magnification, where depth and scale are distorted. Understanding how surgeons adapt eye-hand coordination under the surgical microscope is key to advancing microsurgical education. We investigated gaze behavior and performance differences between expert plastic surgeons and novices during microsurgical suturing. An ocular-mounted eye-tracking system magnetically attached to the microscope preserved naturalistic gaze patterns while maintaining authentic spatial and visual conditions. Suturing was decomposed into phases: needle alignment and tissue piercing, pull-through, and knot tying, for phase-specific analysis. Performance was evaluated using the UWOMSA, and perceived workload was measured with the SURG-TLX. Experts completed the overall task faster than novices, exhibited shorter mean fixations overall, and showed the largest event-level advantage during knot tying. Findings indicate that visual strategies in microsurgery are phase-dependent and expertise-specific. In conclusion, ocular-mounted eye-tracking offers a valuable framework for studying microsurgical visuomotor control and developing objective, data-driven approach for microsurgical training.