Evaluating Surgical Dexterity During Corneal Suturing
Objective: To evaluate motion tracking as an aid to a more objective assessment of ophthalmic microsurgical skill.
Methods: In a cohort study, 3 groups of differing levels of surgical experience were assessed. The groups included novice surgeons (n = 10) with fewer than 5 previously performed corneal sutures, trainee surgeons (n = 10) with 5 to 100 previously performed corneal sutures, and expert surgeons (n = 10) with more than 100 previously performed corneal sutures. The Imperial College Surgical Assessment Device was used for the objective assessment of surgical dexterity during corneal suturing. Each of the subjects used a 10-0 nylon suture in a 3-1-1 pattern on an artificial eye (Royal College of Ophthalmologists, London, England). The Imperial College Surgical Assessment Device measures 3-dimensional spatial vectors via electromagnetic sensors attached to the surgeon's fingers. The number of movements, path length for the respective movements, and time taken to complete the given task were recorded.
Results: Highly statistically significant differences were found between the 3 grades of surgeon experience for time taken (P<.001), number of hand movements (P<.001), and path length of the hand movements (P = .002) to complete the given task.
Conclusions: Motion analysis measured by this technology may be useful in the formal surgical training of residents and as an objective quantitative measure of dexterity.
Saleh GM, Voyazis Y, Hance J, Ratnasothy J, Darzi A
A Technique for Medial Canthal Fixation Using Resorbable Poly-l-Lactic Acid–Polyglycolic Acid Fixation Kit
Achieving secure bony fixation of medial canthus is a challenge. We used a resorbable poly-l-lactic acid–polyglycolic acid screw (LactoSorb office fixation kit) in 5 cases: 2 with traumatic medial canthal dystopia, 1 with scleroderma and orbital fat atrophy causing malapposition of the medial canthus to globe, and 2 with invasive medial canthal tumors necessitating subtotal medial orbital exenteration. The resorbable screw with preplaced suture was drilled into the medial orbital wall, using a handheld self-drilling tap. The preplaced suture was used to anchor the medial canthus. We achieved satisfactory canthal position in all 5 cases. There were no complications in 4 cases during a mean ± SD follow-up of 11.3 ± 6 months; however, the scleroderma case developed wound dehiscence 6 weeks after surgery. The LactoSorb kit is a safe and effective technique to achieve bony medial canthal fixation in carefully selected cases.
Sharma V, Nemet A, Ghabrial R, Martin PA, Kourt G, Danks JJ, Marcells G
Facial Resurfacing for Nonmelanoma Skin Cancer Prophylaxis
Objective: To determine the effect of facial skin resurfacing for treatment of actinic keratoses (AKs) and prophylaxis against new primary basal and squamous cell carcinomas in individuals with previous nonmelanoma skin cancer (NMSC) or severe photodamage.
Design: Randomized, prospective 5-year trial.
Setting: Dermatology and otolaryngology clinics of a Veterans Affairs hospital.
Patients: Thirty-four patients with a history of facial or scalp AKs or basal or squamous cell carcinoma were enrolled. Five of 7 eligible patients who declined study-related treatment were used as controls. Twenty-seven patients were randomized to 3 treatment arms; 3 patients were discontinued from the study.
Interventions: Carbon dioxide laser resurfacing, 30% trichloroacetic acid peel, or 5% fluorouracil cream applied twice daily for 3 weeks.
Main Outcome Measures: Reduction in the number of AKs was measured 3 months after treatment. The incidence of new NMSC in treated areas was assessed between January 1, 2001, and June 30, 2005. Times from baseline to diagnosis of first skin cancer were compared between the treatment and control groups.
Results: Treatment with fluorouracil, trichloroacetic acid, or carbon dioxide laser resulted in an 83% to 92% reduction in AKs (P≤.03), a lower incidence of NMSC compared with the control group (P<.001), and a trend toward longer time to development of new skin cancer compared with the control group (P = .07). However, no significant differences were noted among the treatment groups.
Conclusion: All 3 modalities demonstrated benefit for AK reduction and skin cancer prophylaxis compared with controls and warrant further study in a larger trial.
Hantash BM, Stewart DB, Cooper ZA, Rehmus WE, Koch RJ, Swetter SM
Systemic Toxicity From Topically Applied Lidocaine in Conjunction With Fractional Photothermolysis
Background: Topical anesthetics, unlike injectable anesthetics, can be applied painlessly and can provide sufficient pain control to maintain patient comfort throughout a variety of laser procedures. Although the use of topical lidocaine is considered relatively safe, instances of cardiotoxic and neurotoxic adverse events have been reported to occur.
Observations: A 52-year-old woman underwent fractional photothermolysis for management of severe hypopigmentation and scarring of several years' duration. Shortly after termination of treatment to her face and neck, which required prolonged exposure to a 30% lidocaine gel compound both before and during surgery, she developed clinical signs and symptoms consistent with systemic lidocaine toxicity. The results of laboratory studies confirmed serum lidocaine levels within the toxic range. We postulate that the combination of the high concentration of topical lidocaine required to achieve sufficient anesthesia, together with the laser-induced disruption in epidermal barrier function, may have been responsible for this phenomenon.
Conclusions: Application of a 30% topical lidocaine gel to a limited area in conjunction with fractional photothermolysis may generate serum lidocaine levels high enough to elicit systemic toxicity. Laser surgeons should be alert to this phenomenon, particularly in patients with underlying hepatic, endocrine, cardiac, or central nervous system/psychiatric dysfunction; in patients with a low body mass index; and in patients who are taking medications that may interfere with hepatic lidocaine metabolism.
Marra DE, Yip D, Fincher EF, Moy RL
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2007;9(1):67. doi: