Addressing the MSICS learning curve: identification of instrument-holding techniques used by experienced surgeons
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Kunal S. Parikh. 6035 Smith Building, 400 N. Broadway, Baltimore, MD 21231, USA. ksp@jhu.edu

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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.

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    Abstract:

    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.

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Alexandra J. Berges, Zervin R. Baam, Angela Zhu, et al. Addressing the MSICS learning curve: identification of instrument-holding techniques used by experienced surgeons. Int J Ophthalmol, 2021,14(5):693-699

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Publication History
  • Received:November 11,2020
  • Revised:January 19,2021
  • Adopted:
  • Online: March 29,2021
  • Published: