Factors That Affect Physiologic Tremor and Dexterity During Surgery: A Primer for Neurosurgeons

Fargen, Kyle M; Turner, Raymond D; Spiotta, Alejandro M

doi:10.1016/j.wneu.2015.10.098

Cited by 44 publications

(35 citation statements)

References 52 publications

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“…Risk factors for the enhancement of tremor during surgery have been investigated previously, with the findings of this systematic review forming the basis of our risk factor assessment for tremor [10]. Although the majority of risk factors did not affect our cohort’s performance, students frequently agreed with the statement ‘I feel deprived of sleep’.…”

Section: Discussionmentioning

confidence: 88%

“…These questionnaires were eliciting risk factors for tremor [10], self-perception of anxiety [6] and hand tremor.…”

Section: Methodsmentioning

confidence: 99%

“…Prospective applicants must consider the physical demands the career requires, particularly when considering specialities that demand fine motor skills to perform complex tasks, such as in neurosurgery. Physiological tremor occurs naturally in humans, which can be exacerbated in times of stress [10]. Whilst several hypotheses exist discussing potential mechanisms responsible for hand tremor [1, 5, 16, 18], the exact cause is unclear.…”

Section: Introductionmentioning

confidence: 99%

“…Anxiety has been described as a risk factor for physiological tremor, with pharmacological treatment suggested to provide some benefit to neurosurgical trainees prone to anxiety [10]. Yet, in simulated educational environments, anxiety has been shown not to affect undergraduate student performance [6].…”

Section: Introductionmentioning

confidence: 99%

“…Whilst studies have evaluated tremor in surgical residents and trainees [8, 10, 30], the importance of tremor in undergraduate medical students on their ability to perform microsurgical tasks remains unclear. Essential Skills in the Management of Surgical Cases (ESMSC) [29] is an international surgical course which aims to provide a holistic surgical education to undergraduate medical students.…”

Section: Introductionmentioning

confidence: 99%

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Hands train the brain—what is the role of hand tremor and anxiety in undergraduate microsurgical skills?

et al. 2018

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IntroductionPhysiological hand tremor occurs naturally, due to oscillations of the upper extremities. Tremor can be exacerbated by stress and anxiety, interfering with fine motor tasks and potentially impact on surgical performance, particularly in microsurgery. We investigated the link between tremor, anxiety and performance in a neurosurgical module as part of an international surgical course.MethodsEssential Skills in the Management of Surgical Cases (ESMSC) course recruits medical students from European Union (EU) medical schools. Students are asked to suture the dura mater in an ex vivo swine model, of which the first suture completed was assessed. Questionnaires were distributed before and after the module, eliciting tremor risk factors, self-perception of tremor and anxiety. Johnson O’Connor dexterity pad was used to objectively measure dexterity. Direct Observation of Procedural Skills (DOPS) was used to assess skills-based performance. Anxiety was assessed using the Westside Test Anxiety Scale (WTAS). Tremor was evaluated by four qualified neurosurgeons.ResultsForty delegates participated in the study. Overall performance decreased with greater subjective perception of anxiety (p = 0.032, rho = − 0.392). Although increasing scores for tremor at rest and overall WTAS score were associated with decreased performance, this was not statistically significant (p > 0.05). Tremor at rest did not affect dexterity (p = 0.876, rho = − 0.027).ConclusionsPhysiological tremor did not affect student performance and microsurgical dexterity in a simulation-based environment. Self-perception of anxiety affected performance in this module, suggesting that more confident students perform better in a simulated neurosurgical setting.

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Section: Discussionmentioning

confidence: 88%

“…These questionnaires were eliciting risk factors for tremor [10], self-perception of anxiety [6] and hand tremor.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hands train the brain—what is the role of hand tremor and anxiety in undergraduate microsurgical skills?

et al. 2018

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Association of Weight-Adjusted Caffeine and β-Blocker Use With Ophthalmology Fellow Performance During Simulated Vitreoretinal Microsurgery

et al. 2020

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IMPORTANCE Vitreoretinal surgery can be technically challenging and is limited by physiologic characteristics of the surgeon. Factors that improve accuracy and precision of the vitreoretinal surgeon are invaluable to surgical performance.OBJECTIVES To establish weight-adjusted cutoffs for caffeine and β-blocker (propranolol) intake and to determine their interactions in association with the performance of novice vitreoretinal microsurgeons. DESIGN, SETTINGS, AND PARTICIPANTSThis single-blind cross-sectional study of 15 vitreoretinal surgeons who had less than 2 years of surgical experience was conducted from September 19, 2018, to September 25, 2019, at a dry-laboratory setting. Five simulations were performed daily for 2 days. On day 1, performance was assessed after sequential exposure to placebo, low-dose caffeine (2.5 mg/kg), high-dose caffeine (5.0 mg/kg), and high-dose propranolol (0.6 mg/kg). On day 2, performance was assessed after sequential exposure to placebo, low-dose propranolol (0.2 mg/kg), high-dose propranolol (0.6 mg/kg), and high-dose caffeine (5.0 mg/kg).INTERVENTIONS Surgical simulation tasks were repeated 30 minutes after masked ingestion of placebo, caffeine, or propranolol pills during the 2 days.MAIN OUTCOMES AND MEASURES An Eyesi surgical simulator was used to assess surgical performance, which included surgical score (range, 0 [worst] to 700 [best]), task completion time, intraocular trajectory, and tremor rate (range, 0 [worst] to 100 [best]). The nonparametric Friedman test followed by Dunn-Bonferroni post hoc test was applied for multiple comparisons. RESULTSOf 15 vitreoretinal surgeons, 9 (60%) were male, with a mean (SD) age of 29.6 (1.4) years and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 23.15 (2.9). Compared with low-dose propranolol, low-dose caffeine was associated with a worse total surgical score (557.0 vs 617.

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Introduction and History of Robotics in Neurosurgery

Fomenko

Idrissi

Aji

et al. 2022

Introduction to Robotics in Minimally Invasive Neurosurgery

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Factors That Affect Physiologic Tremor and Dexterity During Surgery: A Primer for Neurosurgeons

Cited by 44 publications

References 52 publications

Hands train the brain—what is the role of hand tremor and anxiety in undergraduate microsurgical skills?

Hands train the brain—what is the role of hand tremor and anxiety in undergraduate microsurgical skills?

Association of Weight-Adjusted Caffeine and β-Blocker Use With Ophthalmology Fellow Performance During Simulated Vitreoretinal Microsurgery

Introduction and History of Robotics in Neurosurgery

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