RESUMEN
BACKGROUND: Operative tremor can greatly influence the outcome of certain, precise, microsurgical operations. Reducing a surgeons tremor may not only improve the operative results but decrease the operative time. Previous studies have only measured uni or bi directional tremor and therefore have been unable to calculate both the overall tremor amplitude and the tremor reduction by resting the wrists. MATERIALS AND METHODS: We measured the tremor of 21 neurologically normal volunteers while performing a micromanipulation task, with and without wrist support. Measurements were acquired in three dimensions using three accelerometers attached to the hand, allowing an overall tremor amplitude to be calculated. RESULTS: Resting the wrist on a gelled surface decreases an individuals tremor by a factor of 2.67 (P = 0). CONCLUSIONS: Supporting the wrists significantly decreases the amplitude of the tremor. Surgeons should consider using wrist supports when performing parts of operations which necessitate a high degree of accuracy.
Asunto(s)
Mano , Microcirugia , Temblor/prevención & control , Adulto , Femenino , Humanos , Masculino , Postura , Articulación de la MuñecaRESUMEN
The objective of this prospective study, performed at two tertiary referral centers in the West Midlands, was to determine if operating has an effect on a surgeon's baseline tremor. A total of 10 head and neck surgery consultants, 2 ENT registrars and 19 normal controls participated in the study. The interventions were preoperative and postoperative tremor measurements for surgeons and pre and post-days' desk work for controls, with the main outcomes measure being the percentage change in tremor. No difference in baseline tremor was determined between consultants and registrars. Operating led to an increase in hand tremor in all subjects. Tremor increases in all subjects were directly proportional to the length of the time spent in operating. Operating compared to a normal day's desk work increased tremor by a factor of 8.4. In conclusion, surgeons should be aware that their tremor will increase as an operation progresses. More complex parts should be performed as early in the day as possible, or, in the case of a very long operation, a change of surgeons may occasionally be necessary.