In Situ Tremor in Vitreoretinal Surgery

Area of Science:

• Ophthalmology
• Surgical Technology
• Biomechanics

Background:

• Surgeon tremor is a critical factor in vitreoretinal surgery precision.
• Current hand support methods differ for same-side dominant (SSD) and contralateral-side dominant (CSD) surgeries.
• It is hypothesized that CSD surgeries exhibit greater tremor and that an asymmetric wrist rest may mitigate this.

Purpose of the Study:

• To quantify surgeon tremor during vitreoretinal surgery under different hand support conditions.
• To evaluate the efficacy of an experimental asymmetric wrist rest in reducing tremor, particularly during CSD surgeries.

Main Methods:

• Analysis of 76 microscope videos from three surgeons performing macular membrane peeling.
• Utilized marker-less motion tracking to record instrument path length and acceleration.
• Measured tremor acceleration magnitude and frequency using spectral analysis before and after implementing an asymmetric wrist rest.

Main Results:

• With a standard symmetric wrist rest, CSD surgeries showed 22% greater average tremor acceleration (0.62 mm/s²) than SSD surgeries (0.51 mm/s²; p=0.05).
• The experimental asymmetric wrist rest eliminated significant differences in tremor acceleration between CSD (0.58 mm/s²) and SSD (0.57 mm/s²) surgeries (p>0.05).

Conclusions:

• The experimental asymmetric wrist support effectively reduced the disparity in surgeon tremor between CSD and SSD vitreoretinal surgeries.
• This novel wrist support has the potential to enhance surgical precision and outcomes by stabilizing instrument control.