Systematic Review of Factors Influencing Surgical Performance: Practical Recommendations for Microsurgical Procedures in Neurosurgery

Belykh, Evgenii; Onaka, Naomi R; Abramov, Irakliy; Yağmurlu, Kaan; Byvaltsev, Vadim A.; Spetzler, Robert F.; Nakaj, Peter; Preul, Mark C.

doi:10.1016/j.wneu.2018.01.005

Cited by 35 publications

(34 citation statements)

References 68 publications

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“…Microsurgical manipulations are possible with 2D visualization under an HD operative microscope, but technically demanding microsurgical techniques require depth perception and high optical resolution to easily and successfully complete tasks and anastomoses. Although there are many factors that can influence microsurgical performance,[ 4 ] the necessity of stereoscopic vision with appropriate depth of focus is essential. In previous studies,[ 24 36 ] only HD resolution was available, likely making it difficult to detect minute details of vessels smaller than 1 mm, particularly adventitia and integrity of intima.…”

Section: Discussionmentioning

confidence: 99%

Microvascular anastomosis under 3D exoscope or endoscope magnification: A proof-of-concept study

Belykh¹,

George²,

Zhao³

et al. 2018

Surg Neurol Int

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Background:Extracranial–intracranial bypass is a challenging procedure that requires special microsurgical skills and an operative microscope. The exoscope is a tool for neurosurgical visualization that provides view on a heads-up display similar to an endoscope, but positioned external to the operating field, like a microscope. The authors carried out a proof-of-concept study evaluating the feasibility and effectiveness of performing microvascular bypass using various new exoscopic tools.Methods:We evaluated microsurgical procedures using a three-dimensional (3D) endoscope, hands-free robotic automated positioning two-dimensional (2D) exoscope, and an ocular-free 3D exoscope, including surgical gauze knot tying, surgical glove cutting, placental vessel anastomoses, and rat vessel anastomoses. Image quality, effectiveness, and feasibility of each technique were compared among different visualization tools and to a standard operative microscope.Results:3D endoscopy produced relatively unsatisfactory resolution imaging. It was shown to be sufficient for knot tying and anastomosis of a placental artery, but was not suitable for anastomosis in rats. The 2D exoscope provided higher resolution imaging, but was not adequate for all maneuvers because of lack of depth perception. The 3D exoscope was shown to be functional to complete all maneuvers because of its depth perception and higher resolution.Conclusion:Depth perception and high resolution at highest magnification are required for microvascular bypass procedures. Execution of standard microanastomosis techniques was unsuccessful using 2D imaging modalities because of depth-perception-related constraints. Microvascular anastomosis is feasible under 3D exoscopic visualization; however, at highest magnification, the depth perception is inferior to that provided by a standard operative microscope, which impedes the procedure.

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Section: Discussionmentioning

confidence: 99%

Microvascular anastomosis under 3D exoscope or endoscope magnification: A proof-of-concept study

Belykh¹,

George²,

Zhao³

et al. 2018

Surg Neurol Int

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“…Belykh et al outlined factors affecting microsurgical performance and provided recommendations to improve performance [3]. They highlighted the negative impacts of alcohol on physiological tremor, the lack of evidence of the benefit of drugs such as beta-blockers and other factors influencing performance.…”

Section: Discussionmentioning

confidence: 99%

“…Elucidating factors affecting microsurgical performance through primary data collection as in our study or evidence synthesis permits optimization of the surgeon’s behaviour and environment. Belykh et al outlined factors affecting microsurgical performance and provided recommendations to improve performance [ 3 ]. They highlighted the negative impacts of alcohol on physiological tremor, the lack of evidence of the benefit of drugs such as beta-blockers and other factors influencing performance.…”

Section: Discussionmentioning

confidence: 99%

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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“…Successful surgery requires a motionless and clear surgical field, and even minimal bleeding interfering with the visualization of the operative area can lead to increased operative time and complications. [28–30] Previous study reports that magnesium sulfate is capable of reducing arterial pressure, heart rate, blood loss, and duration of sinus surgery. [15] Improved quality of the surgical field is observed after magnesium sulfate application during endoscopic sinus surgery.…”

Section: Discussionmentioning

confidence: 99%

The effect of magnesium sulfate on surgical field during endoscopic sinus surgery

Liu

Jiang²,

Pu³

et al. 2019

Medicine

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Introduction: The benefits of magnesium sulfate for surgical field during endoscopic sinus surgery remain controversial. We conduct a systematic review and meta-analysis to explore the influence of magnesium sulfate versus placebo on surgical field during endoscopic sinus surgery. Methods: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2018 for randomized controlled trials (RCTs) assessing the effect of magnesium sulfate versus placebo on surgical field during endoscopic sinus surgery. This meta-analysis is performed using the random-effect model. Results: Four RCTs and 404 patients are included in the meta-analysis. Overall, compared with control group endoscopic sinus surgery, magnesium sulfate has remarkably positive impact on surgical field scores (MD = −1.76; 95% CI = −2.33 to −1.18; P < .00001), and intraoperative blood loss (MD = −89.09; 95% CI = −163.20 to −14.97; P = .02), but shows no markedly effect on surgery duration (MD = −7.08; 95% CI = −21.38 to 7.22; P = .33), fentanyl (MD = −0.64; 95% CI = −1.97 to 0.70; P = .35), and vecuronium (MD = −3.64; 95% CI = −10.99 to 3.70; P = .33). Conclusions: Magnesium sulfate exerts positive impact on surgical field and blood loss reduction for endoscopic sinus surgery.

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Systematic Review of Factors Influencing Surgical Performance: Practical Recommendations for Microsurgical Procedures in Neurosurgery

Cited by 35 publications

References 68 publications

Microvascular anastomosis under 3D exoscope or endoscope magnification: A proof-of-concept study

Microvascular anastomosis under 3D exoscope or endoscope magnification: A proof-of-concept study

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

The effect of magnesium sulfate on surgical field during endoscopic sinus surgery

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