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

2021 ◽  
Vol 14 (5) ◽  
pp. 693-699
Author(s):  
Alexandra J. Berges ◽  
◽  
Angela Zhu ◽  
Shameema Sikder ◽  
Samuel Yiu ◽  
...  
Keyword(s):  
Learning Curve ◽  
Index Finger ◽  
Instrument Design ◽  
Hand Position ◽  
Small Incision Cataract Surgery ◽  
Small Incision ◽  
Universal Language ◽  
Scleral Tunnel ◽  
Wet Lab ◽  
Side Port

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 tripod-forceps 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.

Residents’ Learning Curve for Manual Small-Incision Cataract Surgery at Aravind Eye Hospital, India

Ophthalmology ◽  
2018 ◽  
Vol 125 (11) ◽  
pp. 1692-1699 ◽  
Author(s):  
Sachin Gupta ◽  
Aravind Haripriya ◽  
S. Ashok Vardhan ◽  
Thulasiraj Ravilla ◽  
Ravilla D. Ravindran
Keyword(s):  
Learning Curve ◽  
Cataract Surgery ◽  
Small Incision Cataract Surgery ◽  
Small Incision

scholarly journals Effectiveness of simulation-based training for manual small incision cataract surgery among novice surgeons: a randomized controlled trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Akshay Gopinathan Nair ◽  
Chetan Ahiwalay ◽  
Ashish E. Bacchav ◽  
Tejas Sheth ◽  
Van Charles Lansingh ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Controlled Trial ◽  
Control Group ◽  
Tunnel Construction ◽  
Small Incision Cataract Surgery ◽  
Small Incision ◽  
Conventional Curriculum ◽  
Scleral Tunnel ◽  
Simulation Based ◽  
Novice Surgeons

AbstractThis study was designed to determine the effect of a novel simulation-based training curriculum for scleral tunnel construction in manual small incision cataract surgery (MSICS) compared with traditional training. In this multicenter, investigator-masked, randomized clinical trial, resident surgeons within 3 months of matriculation with minimal or no prior experience with MSICS were assigned either to simulation-based training, the Experimental Group (EG), or to conventional training, the Control Group (CG). EG residents were trained to perform scleral tunnel construction using a simulation-based curriculum (HelpMeSee Eye Surgery Simulator), while residents in the CG followed institution-specific curriculum before progressing to live surgery. Surgical videos of the first 20 attempts at tunnel construction were reviewed by masked video raters. The primary outcome was the total number of any of 9 pre-specified errors. On average, the total number of errors was 9.25 (95% CI 0–18.95) in the EG and 17.56 (95% CI 6.63–28.49) in the CG (P = 0.05); the number of major errors was 4.86 (95% CI 0.13–9.59) in the EG and 10.09 (95% CI 4.76–15.41) in the CG (P = 0.02); and the number of minor errors was 4.39 (95% CI 0–9.75) in the EG and 7.47 (95% CI 1.43–13.51) in the CG (P = 0.16). These results support that novice surgeons trained using the novel simulation-based curriculum performed fewer errors in their first 20 attempts at tunnel construction compared to those trained with a conventional curriculum.

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