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Steady hands

Discussion in 'Clinical Rotations' started by I wanna be a Cardiothoracic Surgeon, Mar 31, 2002.

  1. I wanna be a Cardiothoracic Surgeon

    7+ Year Member

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    I am wondering how, say a microsurgeon, keeps their hands so exceedingly still! Do they train you certain techniques as to how to keep them calm and not shaking, or does it come from pactice after practice? I try to keep my hands still just using a pen, and I can do it but there are small jitters. How does a microsurgeon keep them so still that they can direct a needle the size of a human hair through blood vessels under a microscope?

    Thanks for all the help!
     
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  3. droliver

    Moderator Emeritus 10+ Year Member

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    There are a # of things you do to limit your tremor (which everyone has to some degree).
    - limiting caffeine
    - limiting upper extremity weight lifting

    Specifically for microsurgery you prop up your forearms on surgical towels which helps a lot. Proper posture is also critical.

    Some people with pronounced essential tremors have to take beta-blockers to operate, especially on vascular cases
     
  4. SurgeonS4

    SurgeonS4 Member
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    damn . . . beta blockers? thats unbelievable . .. yeah my hands are pretty steady . . . but wow microsurgery
     
  5. Scooby Doo

    Scooby Doo IEatShavedPussyCats
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    droliver,

    How does limiting upper body weightlifting help with that?
    I guess I am out of the running for microsurgery now :) haha
     
  6. droliver

    Moderator Emeritus 10+ Year Member

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    weights will increase your resting muscle tone and give you more pronounced fine tremors
     
  7. EidolonSix

    EidolonSix Member
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    Conditioning, conditioning, conditioning.

    My research requires me to ligate rat LADs with 6-0 prolene. A missed swipe and the rat is toast. My success rate increased dramatically over my first cases as I learned how to position my hand and maintain control over the needle.

    The same, but finer control is needed in microsurgery...most of the motion is limited to the fingertips. A tech in our lab frequent does ligations on mice....less than 50 grams, using 10-0 prolene. I personally have done some procedures on lab animals with such small suture and loupes and can say....it is not easy....but skill is dependent upon experience.

    I've seen some surgeons with fine essential tremors, that had learned how to manage their tremor and perform beautiful procedures.
     
  8. maccloud

    maccloud New Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by droliver:
    <strong>weights will increase your resting muscle tone and give you more pronounced fine tremors</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I never heard of this... but I don't doubt you. But even if it is true that strength training leads to increased resting muscle tone leads to increased fine tremors, are there any "outcome" studies to show that this leads to worse microsurgery? In other words, in real practice, do people with bigger UE truly have more difficulty with microsurgery or have fewer working anastomoses or have more pt morbidity and mortality?

    Also, is poor microsurgery due to tremors in the fingertips or forearms or arms? If it's fingers, and I realize that most muscle bellies controlling the hand lie in the forearm (but not all of them), then wouldn't big arms not really affect finger tremor very much?
     
  9. Kasey

    Kasey Member
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    I've been a musician all my life and have been told often not to bulk up my arms/shoulders (I was a shot/discus thrower in high school and was in the habit of hitting the weight room) because it would lead to shaking. I think the idea was not so much loss of motor control in this case (well, at least not as dramatically as it would be with something on the order of microsurgery, you don't need as fine control to play a stringed instrument, but you do need a pretty steady hand), but the fact that the muscles weren't able to relax as easily, but I never questioned it. Basically, you tense up and start shaking. Couldn't say why, but I definitely know all the people I knew that did lift on a regular basis had many more control problems than others that didn't.
    -K
     
  10. chef

    chef Senior Member
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    anyone know of any surgeons with big UE and still does good vascular or other microsurgery?
     
  11. jchoiny

    jchoiny New Member

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    Well...... I know of a microsurgery guru who works out regularly with weights. He happens to be one of the most well respected reconstructive plastic surgeons in the country, and usually does a few free flaps a week with great results. In fact, he is one of the most technically gifted surgeons that I have seen regardless of surgical subspecialties.

    He doesn't have a massive UE, but lifts everyday, nevertheless. Maybe exercise style matters, i.e. lots of reps with smaller weights versus heavy weight lifting. . . ?
     
  12. dankatzzz

    dankatzzz Member
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    There are robots now adays that mitigate the tremor in our hands and make microsuregery more stable. I saw one on The Learning Channel where a cardiac surgery was being done. These have software programs that insure that there are no wild erratic movements
     

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