Manual dexterity refers to the ability to use one's hands and fingers with skill and coordination to perform complex tasks.
In the case of a neurosurgeon, manual dexterity is of utmost importance as they are required to perform intricate surgeries on the brain, spinal cord, and nerves. They must have excellent fine motor skills, a steady hand, and precise movements to perform delicate procedures in tight spaces.
Neurosurgeons often use specialized surgical instruments, including microscopes and endoscopes, to visualize and operate on the nervous system. They must be able to manipulate these instruments with great accuracy and control to minimize the risk of complications and maximize the chances of a successful outcome.
To develop and maintain their manual dexterity, neurosurgeons often engage in specialized training and practice. This may involve using surgical simulators, performing mock surgeries on cadavers, or participating in continuing education courses to refine their skills.
Certain studies have linked fatigue and sleep deprivation to worsened surgical dexterity. There are, to date, no reviews of this topic in published surgical literature. It therefore seems prudent to evaluate such behaviors and provide the neurosurgical community with the most current evidence on the topic so that learners and those responsible for their training may understand the potential consequences of their decisions on procedural dexterity and performance 1).
Omnidirectional articulated instruments enhance dexterity.
Conway et al. developed two novel individuation scores and tested them against a previously developed score using a commercially available instrumented glove and data collected from 20 healthy adults. Participants performed individuation for each finger of each hand as well as the whole hand open-close at two study visits separated by several weeks. Using the three individuation scores, intra-class correlation coefficients (ICC) and minimal detectable changes (MDC) were calculated. Individuation scores were further correlated with subjective assessments to assess validity.
They found that each score emphasized different aspects of individuation performance while generating scores on the same scale (0 [poor] to 1 [ideal]). These scores were repeatable, but the quality of the metrics varied by both equation and finger of interest. For example, index finger intra-class correlation coefficients (ICC's) were 0.90 (< 0.0001), 0.77 (< 0.001), and 0.83 (p < 0.0001), while pinky finger ICC's were 0.96 (p < 0.0001), 0.88 (p < 0.0001), and 0.81 (p < 0.001) for each score. Similarly, MDCs also varied by both finger and equation. In particular, thumb MDCs were 0.068, 0.14, and 0.045, while index MDCs were 0.041, 0.066, and 0.078. Furthermore, objective measurements correlated with subjective assessments of finger individuation quality for all three equations (ρ = - 0.45, p < 0.0001; ρ = - 0.53, p < 0.0001; ρ = - 0.40, p < 0.0001).
They provide a set of normative values for three separate finger individuation scores in healthy adults with a commercially available instrumented glove. Each score emphasizes a different aspect of finger individuation performance and may be more uniquely applicable to certain clinical scenarios. They hope for this platform to be used within and across centers wishing to share objective data in the physiological study of hand dexterity. In sum, this work represents the first healthy participant data set for this platform and may inform future translational applications in motor physiology and rehabilitation labs, orthopedic hand and neurosurgery clinics, and even operating rooms 2)
Findings suggest that three dimensional endoscopy modality provides improved surgical dexterity by affording the surgeon with depth perception when manipulating tissue and maneuvering the endoscope in the endonasal corridor 3).
Junior residents and expert surgeons performed standardized motor tasks under microscopic and endoscopic visualization. Demerits for inaccuracy and time needed to complete the tasks were used to compare the surgeons' performance with the microscope and the endoscope. The participants also performed a motor task under direct vision using different instruments to evaluate whether the shape of the instrument had any impact on the surgical fidelity.
For the junior residents, the number of demerits accrued was lower with the microscope than with the endoscope, and the time needed to complete the tasks was also lower with the microscope. There was no difference in the number of demerits between the microscopic and the endoscopic experts, but the microscopic expert completed the task in a shorter time. There was no difference in demerits or performance time when comparing a short, straight instrument and a longer, bayoneted one.
For junior residents, surgical fidelity is higher with the microscope than with the endoscope. This difference vanishes with experience, but a slower speed of execution is observed with endoscopic visualization, both in junior and expert surgeons 4).
In neurosurgery, for example, the simultaneous use of 2 instruments through the same endoscopic shaft remains a difficult feat. It is, however, very challenging to manufacture steerable instruments of the requisite small diameter.
Dewaele et al. present a new technique to produce such instruments by means of laser cutting. Only 3 coaxial tubes are used. The middle tube has a cutting pattern that allows the steering forces to be transmitted from the proximal to the distal end. In this way the steering part is concealed in the wall of the tube. Large diameter articulated instruments such as for laparoscopy might benefit from the excellent tip stability provided by the same economical technology. Method. Coaxial nitinol tubes are laser-cut with a Rofin Stent Cutter in a specific pattern. The 3 tubes are assembled by sliding them over one another, forming a single composite tube. In a surgical simulator, the neurosurgical microinstruments and laparoscopic needle drivers were evaluated on surgical convenience. Results. Simultaneous use of 2 neurosurgical instruments (1.5 mm diameter) through the same endoscopic shaft proved to be very intuitive. The tip of the steerable laparoscopic instruments (10 mm diameter) could resist a lateral force of more than 20 N. The angle of motion for either instrument was at least 70° in any direction. Conclusions. A new design for steerable endoscopic instruments is presented. It allows the construction in a range from microinstruments to 10-mm laparoscopic devices with excellent tip stability 5).
Cerebrovascular anastomosis (for example in the management of Moyamoya disease or complex aneurysms) is a rarely performed but essential procedure in neurosurgery. Because of the complexity of this technique and the infrequent clinical opportunities to maintain skills relevant to this surgery, laboratory training is important to develop a consistent and competent performance of cerebrovascular anastomosis. We reviewed the literature pertaining to the training practices surrounding cerebrovascular anastomosis in order to understand the ways in which trainees should best develop these skills. A wide variety of training methods have been described. These may be classified into five general categories, according to training materials used, being synthetic material, living animal, animal carcass, human cadaver, and computer simulation. Ideally, a novice begins training with non-biological material. After gaining sufficient dexterity, the trainee will be able to practice using biological materials followed by high fidelity models prior to actual surgery. Unfortunately, the effectiveness of each model has generally, only been judged subjectively. Objective quantification methods are necessary to accelerate the acquisition of competence 6).