Addressing the MSICS learning curve: identification of instrument-holding techniques used by experienced surgeons  

作　　者：Alexandra J.Berges Zervin R.Baam Angela Zhu Shameema Sikder Samuel Yiu Ravilla D.Ravindran Kunal S.Parikh 

机构地区：[1]Johns Hopkins University School of Medicine,Baltimore,MD 21287,USA [2]Aravind Eye Hospital,Madurai,Tamil Nadu 625001,India [3]Wilmer Eye Institute,Baltimore,MD 21287,USA [4]Center for Nanomedicine,Baltimore,MD 21231,USA [5]Department of Biomedical Engineering,Baltimore,MD 21218,USA [6]Center for Bioengineering Innovation&Design,Baltimore,MD 21218,USA

出　　处：《International Journal of Ophthalmology(English edition)》2021年第5期693-699,共7页国际眼科杂志（英文版）

基　　金：Supported by Dana Center for Preventative Ophthalmology,Wilmer Eye Institute,Johns Hopkins University School of Medicine,Baltimore,Maryland 21287;Johns Hopkins School of Medicine Dean’s Summer Research Funding,Johns Hopkins University School of Medicine,Baltimore,Maryland 21205-2196。

摘　　要：AIM: To identify instrument holding archetypes used by experienced surgeons in order to develop a universal language and set of validated techniques that can be utilized in manual small incision cataract surgery(MSICS) curricula. METHODS: Experienced cataract surgeons performed five MSICS steps(scleral incision, scleral tunnel, side port, corneal tunnel, and capsulorhexis) in a wet lab to record surgeon hand positions. Images and videos were taken during each step to identify validated hand position archetypes.RESULTS: For each MSICS step, one or two major archetypes and key modifying variables were observed, including tripod for scleral incision, tripod-thumb bottom for scleral tunnel, underhand-index to thumb grip for side port, index-contact tripod for corneal entry, and tripodforceps for capsulorhexis. Key differences were noted in thumb placement and number of fingers supporting the instrument, and modifying variables included index finger curvature and amount of flexion.CONCLUSION: Identification of optimal hand positions and development of a formal nomenclature has the potential to help trainees adopt hand positions in an informed manner, influence instrument design, and improve surgical outcomes.

关 键 词：CATARACT manual small incision cataract surgery instrument holding TRAINING learning curve 

分 类 号：R779.6[医药卫生—眼科]