Overcoming the impact of physiologic tremors in ophthalmology.

Gurfarmaan Singh, Wilson Wong Jun Jie, Michelle Tian Sun, Robert Casson, Dinesh Selva, WengOnn Chan
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Abstract

Purpose: Ophthalmic surgery involves the manipulation of micron-level sized structures such as the internal limiting membrane where tactile sensation is practically absent. All humans have physiologic tremors that are of low amplitude and not discernible to the naked eye; they do not adversely affect the majority of the population's daily functioning. However, during microsurgery, such tremors can be problematic. In this review, we focus on the impact of physiological tremors on ophthalmic microsurgery and offer a comparative discussion on the impact of such tremors on other surgical specialties.

Methods: A single investigator used the MEDLINE database (via PubMed) to search for and identify articles for inclusion in this systematic review. Ten key factors were identified as potentially having an impact on tremor amplitude: beta-blockers, muscle fatigue, robotic systems, handheld tools/micromanipulators, armrests/wrist supports, caffeine, diet, sleep deprivation, consuming alcohol, and workouts (exercise). These key terms were then searched using the advanced Boolean search tool and operators (i.e., AND, OR) available on PubMed: (*keyword*) AND (surgeon tremor OR microsurgery tremor OR hand steadiness OR simulator score).

Results: Ten studies attempted to quantify the baseline severity of operator physiologic tremor. Approximately 89% of studies accessing the impact of tremors on performance in regards to surgical metrics reported an improvement in performance compared to 57% of studies concluding that tremor elimination was of benefit when considering procedural outcomes.

Conclusions: Robotic technology, new instruments, exoskeletons, technique modifications, and lifestyle factors have all demonstrated the potential to assist in overcoming tremors in ophthalmology.

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克服眼科生理性震颤的影响。
目的:眼科手术涉及到微米级结构的操作,如内部限制膜,在那里触觉几乎不存在。所有人都有低幅度的、肉眼无法识别的生理性震颤;它们不会对大多数人的日常生活产生不利影响。然而,在显微外科手术中,这样的震动可能是有问题的。在这篇综述中,我们重点讨论了生理震动对眼科显微外科的影响,并对此类震动对其他外科专业的影响进行了比较讨论。方法:一名研究者使用MEDLINE数据库(通过PubMed)搜索并确定纳入本系统评价的文章。确定了可能影响震颤幅度的十个关键因素:-受体阻滞剂、肌肉疲劳、机器人系统、手持工具/微操纵器、扶手/手腕支撑、咖啡因、饮食、睡眠剥夺、饮酒和锻炼。然后使用PubMed上提供的高级布尔搜索工具和运算符(即and, OR)搜索这些关键术语:(*关键字*)and(外科医生震颤或显微外科震颤或手稳定性或模拟器评分)。结果:10项研究试图量化操作者生理性震颤的基线严重程度。大约89%的研究涉及震颤对手术性能的影响,报告了手术性能的改善,而57%的研究得出结论,在考虑手术结果时,震颤消除是有益的。结论:机器人技术、新仪器、外骨骼、技术改进和生活方式因素都显示出帮助克服眼科震颤的潜力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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