"Finger-Touch Approach" for Novice Microsurgical Assistants: A Simulation Study

Microsurgical procedures demand precise hand-eye coordination, yet the surgeon's hands often remain outside the visual field until instruments enter the microscope view, impairing spatial awareness. We developed the finger-touch approach (FTA) to provide an additional proprioceptive reference point, hypothesizing it would improve safety and confidence without compromising efficiency.

A simulation task was designed to replicate microsurgical suture-cutting assistance, one of the most common procedures performed by a microsurgery assistant. Postgraduate-year 1 to 2 junior residents (JR), and plastic surgery residents/fellows (PSF) performed the task using two approaches: a conventional method and the FTA, which involved touching the instrument to the assistant's index finger before entering the microscopic field. The number of unintended contacts, time to reach the microscopic field, and trajectory variability were measured. Microsurgical precision and psychological responses were compared between the methods.

Eighteen JRs and five PSFs participated. FTA significantly reduced unintended contacts among JRs compared with the conventional approach (0.1 vs. 0.0, p = 0.003), without affecting the time to reach the field or trajectory variability. In contrast, no significant differences were observed among PSFs. Posttask questionnaire revealed higher positive psychological responses among JRs compared with PSFs in comfort with the FTA (94.4% vs. 40.0%, p = 0.021) and interest in incorporating the technique into actual surgery (100% vs. 60.0%, p = 0.040).

FTA improves safety and psychological comfort among novice microsurgical assistants. The technique requires minimal instruction without additional equipment, making it readily implementable in training programs and clinical practices for beginners.