ASSESSMENT of SIMULATED SURGICAL DEXTERITY after MODIFIABLE EXTERNAL EXPOSURES among NOVICE VERSUS EXPERIENCED VITREORETINAL SURGEONS

Marina Roizenblatt, Peter L. Gehlbach, Vitor D.G. Marin, Arnaldo Roizenblatt, Vinicius Da S. Saraiva, Mauricio H. Nakanami, Luciana Da C. Noia, Sung E.S. Watanabe, Erika S. Yasaki, Renato M. Passos, Octaviano Magalhães, Rodrigo A.B. Fernandes, Francisco R. Stefanini, Rafael Caiado, Kim Jiramongkolchai, Michel E. Farah, Rubens Belfort, Mauricio Maia

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose:To evaluate novice and senior vitreoretinal surgeons after various exposures. Multiple comparisons ranked the importance of these exposures for surgical dexterity based on experience.Methods:This prospective cohort study included 15 novice and 11 senior vitreoretinal surgeons (<2 and >10 years' practice, respectively). Eyesi-simulator tasks were performed after each exposure. Day 1, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine; day 2, placebo, 0.2 mg/kg propranolol, and 0.6 mg/kg propranolol; day 3, baseline simulation, breathalyzer readings of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentrations; day 4, baseline simulation, push-up sets with 50% and 85% repetitions maximum; and day 5, 3-hour sleep deprivation. Eyesi-generated score (0-700, worst-best), out-of-Tolerance tremor (0-100, best-worst), task completion time (minutes), and intraocular pathway (in millimeters) were measured.Results:Novice surgeons performed worse after caffeine (-29.53, 95% confidence interval [CI]:-57.80 to-1.27, P = 0.041) and alcohol (-51.33, 95% CI:-80.49 to-22.16, P = 0.001) consumption. Alcohol caused longer intraocular instrument movement pathways (212.84 mm, 95% CI: 34.03-391.65 mm, P = 0.02) and greater tremor (7.72, 95% CI: 0.74-14.70, P = 0.003) among novices. Sleep deprivation negatively affected novice performance time (2.57 minutes, 95% CI: 1.09-4.05 minutes, P = 0.001) and tremor (8.62, 95% CI: 0.80-16.45, P = 0.03); however, their speed increased after propranolol (-1.43 minutes, 95% CI:-2.71 to-0.15 minutes, P = 0.029). Senior surgeons' scores deteriorated only following alcohol consumption (-47.36, 95% CI:-80.37 to-14.36, P = 0.005).Conclusion:Alcohol compromised all participants despite their expertise level. Experience negated the effects of caffeine, propranolol, exercise, and sleep deprivation on surgical skills.

Original languageEnglish (US)
Pages (from-to)820-830
Number of pages11
JournalRetina
Volume44
Issue number5
DOIs
StatePublished - May 1 2024

Keywords

  • Eyesi simulator
  • alcohol
  • caffeine
  • exercise
  • preoperative exposures
  • propranolol
  • sleep deprivation
  • surgical experience
  • vitreoretinal surgery

ASJC Scopus subject areas

  • Ophthalmology

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