Surgeon Handedness Research Articles

Does the Surgeon's Handedness Affect the Complications Rate in the Inframammary Approach Breast Augmentation?

Humans show a preference for left or right handedness in most cases. For this reason, surgeons might find it more difficult to operate on the "nondominant breast", i.e. the breast opposite to the surgeon´s dominant hand (left breast for right-handed surgeons and right breast for left-handed surgeons). The nondominant breast might therefore potentially be prone to a higher complication rate. Retrospective data of all consecutive patients who underwent breast augmentations by the first author over the past 15years was reviewed. In all cases, the entire operation was carried out with the surgeon standing on the right side of the table. All the complications of the right and left breasts were analyzed individually. 1707 patients with a minimum follow-up of sixmonths were reviewed. Mean breast implant volume was 305.6 cc and mean follow-up was 16.12months. A total of 151 complications were found (8.8%), including rotational deformity, capsular contracture, hematoma, seroma, bottoming out, high riding implant, double bubble deformity, implant rupture and infection. Of these complications, 77 (4.51%) affected the left breast, 48 (2.87%) were found on the right breast and 25 (1.46%) were bilateral. This difference was statistically significant. Surgeons´ handedness seem to have an impact on the rate of complications after breast augmentation. As a result of some sort of unease when operating on the nondominant breast, this side might be prone to less precision during the dissection and, consequently, to more complications. Our study found that the rate of complications was higher in the nondominant breast. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Risk factors for corneal conjunctival grafting failure in dogs at four referral centers in the southern United States (203patients): 2015-2021.

To report risk factors associated with conjunctival graft failure in dogs at four referral specialty centers. Records of 203 dogs (229 eyes) undergoing conjunctival graft repair of ulcerative keratitis at four hospitals from 2015 to 2021 were reviewed. Success was defined as full graft integration with globe retention at the last postoperative evaluation; vision status was reported separately. Factors assessed included patient signalment, ophthalmic examination findings, surgical factors, and follow-up information. Conjunctival graft failure occurred in 11% (25/229) of eyes and was significantly associated with ulcer depth, with corneal perforations having increased odds of graft failure compared with descemetoceles (odds ratio [OR] = 3.22, 95% confidence interval [CI] 1.11-9.32; p = .03) and stromal ulcers (OR = 10.89 [95% CI 1.38-86.18], p = .02). Brachycephalic dogs were significantly more likely than non-brachycephalic dogs to experience graft failure (OR = 5.02 [95% CI 1.42-17.74], p < .01). Surgery on the opposite eye relative to surgeon handedness was significantly associated with an increased risk of graft failure (OR 4.28 [95% CI 1.53-11.94], p < .01). The use of 7-0 and 8-0 suture versus 9-0 (p = .03) and the use of a combined simple continuous and interrupted pattern (p = .03) were significantly associated with an increased risk of graft failure. At the last follow-up, (median 61.5 days), 87% of dogs were visual. Corneal perforations, surgery on the opposite eye relative to surgeon handedness, suture size and pattern, and brachycephalic conformation were significantly associated with an increased risk of graft failure in this study. These characteristics can be considered when determining prognosis for ulcerative keratitis requiring surgical intervention.

Effects of Surgeon Handedness on the Outcomes of Unicompartmental Knee Arthroplasty: A Single Center's Experience.

Surgeon handedness has been widely discussed in operative surgery, and could cause clinical discrepancy. However, few studies have reported the effect of handedness on unicompartmental knee arthroplasty (UKA). Based on our clinical observation and case analysis, we aimed to find out the effects of surgeon handedness on UKA. We retrospectively studied 94 UKA procedures performed by one right-handed surgeon from January 2017 to December 2018 at a single medical center. The cases were divided into two groups by operation side (49 L-UKAs and 45 R-UKAs). Preoperative demographic data were collected. Imaging parameters (femorotibial and hip-knee-ankle angles and tibial-plateau retroversion) and joint function scores (Knee Society Score [KSS] and Oxford Knee Score [OKS]) were recorded. Patients were followed up regularly and Forgotten Joint Score (FJS) was calculated at the last follow-up. All data were compared between the two groups with independent-samples t-test, and paired t-test was used for intragroup comparisons. The average follow-up was 26.7 ± 3.2 months. The average patient age was 63.5 ± 9.0 years and the average body mass index was 26.89 ± 3.43 kg/m2 . There was no significant group difference in any preoperative characteristic. Both the KSS and OKS improved significantly after surgery (p < 0.05). No significant group difference was found between the KSS or OKS at any follow-up visit. The varus or valgus of tibial component was 3.57 ± 1.42° on the left side and 3.19 ± 1.56° on the right side (p=0.45). The varus or valgus of femoral component was 7.81 ± 2.43° in patients undergoing L-UKA and 7.05 ± 2.90° in those undergoing R-UKA (p=0.04). No statistical differences were found in outliers of component orientation on both sides. The femorotibial and hip-knee-ankle angles improved significantly in both groups, and there was no significant group difference in either lower limb alignment or tibial-plateau retroversion. The complication rate was 8.16% (4/49) in the L-UKA group and 6.67% (3/45) in the R-UKA group. There was no correlation between prosthesis orientation and early joint function score. Surgeon handedness may cause a worse prosthetic orientation on femoral side during surgeon's non-dominant UKA, and surgeons should be cautious of bone resection and prosthesis implantation. However, radiographic difference did not bring variations on short-term clinical outcomes or lower limb alignment.

The Relationship of Surgeon Handedness and Experience on Operative Duration and Hearing Improvement in Ipsilateral and Contralateral Otologic Surgeries

ABSTRACT&#x0D; Objective: To determine the relationship of the surgeon handedness and operative site laterality on operative duration and hearing improvement in otologic surgery, and to further explore whether this relationship may be related to surgeon experience.&#x0D; Methods:Design: Retrospective CohortSetting: Tertiary Private Teaching HospitalParticipants: Seventy-three (73) patients aged 18 to 65 years old who underwent primary ear surgery under general anesthesia between January 2016 and December 2019 were retrospectively divided into two groups: 39 contralateral and 34 ipsilateral. The operative durations and hearing improvements were compared using independent t-tests, with consideration of surgeon experience in years further stratifying patients.&#x0D; Results: There was no significant difference in operative duration, t(71) = 1.14, p = .26, between the contralateral (M = 281.95 minutes, SD = 71.82) and ipsilateral (M = 261.15, SD = 79.26) groups. This same pattern was more pronounced among surgeons with 10+ years of experience although there was also no significant difference in operative time, t(33) = 1.31, p = .19 for both ipsilateral and contralateral surgeries There was no statistically significant difference, t(36) = -0.72, p = .47, in overall mean hearing gain among patients in the contralateral (M = +2.22 dB, SD = 10.54) and ipsilateral (M = +5.12 dB, SD = 14.26) groups. Although the difference was also not statistically significant, t(16) = -1.94, p = .07 for contralateral (M = 0.00, SD = 5.43) and ipsilateral (M = +7.95 dB, SD = 11.52) procedures performed by surgeons with experience of 10 years or more, a mean hearing gain of +7 dB in the ipsilateral group compared to 0 dB in the contralateral group was notable.&#x0D; Conclusion: This study did not prove that regardless of surgeon experience, right-handed surgeons operating on the right ear and left-handed surgeons operating on the left ear have better ear surgery outcomes of operative duration and hearing improvement compared to right- handed surgeons operating on the left ear and left-handed surgeons operating on the right ear. Future studies on larger samples with more complete data may yet demonstrate this effect.

Effect of surgeon's handedness on distribution of prosthesis during primary total knee arthroplasty

To evaluate the effect of the surgeon's handedness on the distribution of prosthesis during primary total knee arthroplasty (TKA). A retrospective analysis was performed on 86 patients (100 knees) with primary TKA completed by the same right-handed surgeon between December 2016 and December 2018, including 72 cases of single knee and 14 of bilateral knees. The patients were divided into dominant group (right side) and non-dominant group (left side) according to the operating position of the surgeon and each group had 50 knees. There was no significant difference in gender, age, body mass index, disease duration, clinical diagnosis, preoperative Hospital for Special Surgery (HSS) score, and other general data between the two groups ( P>0.05). The operation time and complications were recorded in both groups. The function of knee was evaluated by HSS score. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured by using X-ray film of full-length lower extremity before TKA and at 2 weeks after TKA that were used to evaluate the coronal position of the prosthesis. Posterior distal femoral angle (PDFA) and posterior proximal tibial angle (PPTA) were measured by using lateral X-ray films at 3 months after operation that were used to evaluate the sagittal position of the prosthesis. There was no significant difference in operation time between the two groups ( t=-1.128, P=0.262). One case of posterior tibial artery thrombosis occurred in the dominant group, and 1 case of poor healing of the incision occurred in each of the dominant group and the non-dominant group. Patients in both groups were followed up 12-34 months with an average of 22.0 months. The HSS scores at last follow-up were 87.2±4.3 in the dominant group and 86.8±5.0 in the non-dominant group. There was no significant difference between the two groups ( t=0.471, P=0.639). No complications such as periprosthetic infection, prosthetic loosening, or periprosthetic fracture occurred during follow-up. There was no significant difference in the HKA, mLDFA, and mMPTA between the two groups before and after operation ( P>0.05). The differences in the incidence of sagittal femoral prosthesis malposition and PDFA between the two groups were significant ( P<0.05); however, there was no significant difference in the PPTA, the rate of femoral prosthesis distributed in the neutral position, the incidence of over-flexed femoral prosthesis, and the incidence of anterior femoral notch ( P>0.05). The surgeon's handedness is one of the factors affecting the placement of the sagittal femoral prosthesis in primary TKA. The incidence of sagittal femoral prosthesis malposition could increase when the surgeon performs on the non-dominant side.

Impact of surgeon handedness in manual and robot-assisted total hip arthroplasty

BackgroundThe purpose of this study was to examine whether surgeon handedness could affect cup positioning in manual total hip arthroplasty (THA), and whether robot could diminish or eliminate the impact of surgeon handedness on cup positioning in robot-assisted THA.MethodsFifty-three patients who underwent bilateral robot-assisted THA and sixty-two patients who underwent bilateral manual THA between August 2018 and July 2019 in our institute were respectively analyzed in this study. When the difference between the bilateral anteversion and inclination was greater than 5°, the patient was regarded as having different cup positioning between bilateral THA. Their demographics, orientation of acetabular cup, and postoperative 3 month Harris hip score (HHS) were recorded for analysis.ResultsThere were no significant differences in the gender, age, BMI, diagnosis’s composition, and preoperative and postoperative HHS between the robotic and manual group. Two left hips dislocated in the manual group. The anteversion of left hip was significantly larger than that of right hip (24.77 ± 10.44 vs 22.44 ± 8.67, p = 0.043) in the manual group. There were no significant differences of cup positioning between bilateral robot-assisted THA. The patients in manual group were significantly more likely to have different cup positioning between bilateral hips than those in robotic group (77% vs 45%, p = 0.000). More manual THA were located out of the target zone than robot-assisted THA (70% vs 48%, p = 0.001).ConclusionsSurgeon’s handedness showed a trend towards an impact on cup positioning in manual THA and robot might help surgeon eliminate the adverse impact. However, the impact of handedness on the clinical outcomes still needs further observation.

2040 Three-Arm Robotic Hysterectomy: Choreography for the Trainee

Video Objective To Demonstrate Robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oopherectomy (TLHBSO) using 3 arms and a uterine manipulator Setting The da Vinci XI Platform is used to perform a simple extrafascial TLHBSO Interventions A step-by-step choreography demonstrates 5 main exercises of a robot-assisted TLHBSO mainly; 1- The posterior dissection, 2- The anterior dissection, 3- The lateral dissection, 4- The colpotomy, 5- The cuff closure and suspension. Attention is drawn to the position of the uterus and the direction of counter-traction necessary to complete each step. The function of the third arm is emphasized. Relevant anatomy shown. Necessary laparoscopic surgical techniques demonstrated. Conclusion The principles of this step-by-step choreographed method can be reproducible with every platform, docking preference, and surgeon handedness. The 5 exercises break down the procedure for the trainee as specific tasks to complete and master separately. This facilitates the learning process and maintains operating room efficiency. To Demonstrate Robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oopherectomy (TLHBSO) using 3 arms and a uterine manipulator The da Vinci XI Platform is used to perform a simple extrafascial TLHBSO A step-by-step choreography demonstrates 5 main exercises of a robot-assisted TLHBSO mainly; 1- The posterior dissection, 2- The anterior dissection, 3- The lateral dissection, 4- The colpotomy, 5- The cuff closure and suspension. Attention is drawn to the position of the uterus and the direction of counter-traction necessary to complete each step. The function of the third arm is emphasized. Relevant anatomy shown. Necessary laparoscopic surgical techniques demonstrated. The principles of this step-by-step choreographed method can be reproducible with every platform, docking preference, and surgeon handedness. The 5 exercises break down the procedure for the trainee as specific tasks to complete and master separately. This facilitates the learning process and maintains operating room efficiency.

Does surgeon handedness or experience predict immediate complications after mastectomy? A critical examination of outcomes in a single health system

Surgeons often seek to perfect their technical dexterity, and hand dominance of the surgeon is an important factor given the constraints of operative field laterality. However, experience often dictates how surgeons are able to compensate. While surgeons have experienced preference for the ipsilateral breast, the impact of surgeon handedness, experience, and volume has not been directly examined in a single study. A retrospective chart review of five breast surgeons (2 LHD) at a single institution identified 365 mastectomy patients, totaling 594 breasts, between January 2015 and June 2018. The breasts were identified as ipsilateral or contralateral based on the surgeons' handedness. Surgeons were grouped based on length of surgical experience, three with≥15years and two with<15years. Surgeons with greater experience were the highest volume surgeons in this series. Data included patient demographics, breast and oncologic history, surgical techniques, and surgical outcomes including complications. A total of 270 nonprophylactic and 324 prophylactic mastectomies were identified, of which 529 were performed by surgeons with greater than 15years of experience and 65 by surgeons with less than 15years. The overall complication rate was 33.5% (n=199), of which 18.0% (n=107) were on the ipsilateral breast and 15.5% (n=92) were on the contralateral breast. 9.1% of complications required re-operation (n=54). The odds of any complication on the ipsilateral breast were 2.9 times higher than complications on the contralateral breast when looking exclusively at surgeons with<15years of experience (P=.0353, OR=2.92, 1.06-8.03). Surgeons with<15years of experience have a 2.71 (P=.05, OR 2.71, 1.361-5.373) increase in any ischemic complication and a 16 times (P<.0001, OR=16.01, 5.038-50.933) increase in major operative ischemic complications. Our study finds that surgeons with less than 15years of surgical experience have a 2.9 times higher rate of overall complication when operating on the ipsilateral breast. However, years of experience and surgeon volume have a much greater impact on any and ischemic complications after mastectomy.

Is the cup orientation different in bilateral total hip arthroplasty with right-handed surgeons using posterolateral approach?

BackgroundThe impact of surgeon handedness on acetabular cup orientation in total hip arthroplasty (THA) is not well studied. The aim of our study is to investigate the difference of cup orientation in bilateral THA performed by right-handed surgeons using posterolateral approach and which cup could be fitter to Lewinneck’s safe zone.MethodsThe study consisted of 498 patients that underwent bilateral THA by three right-handed surgeons in our hospital. Postoperative acetabular cup anteversion and abduction on an anteroposterior pelvic radiograph were measured by Orthoview software (Orthoview LLC, Jacksonville, Florida). Furthermore, the percentage of cup placement within the safe zone was compared.ResultsThe mean anteversion was 25.28 (25.28° ± 7.16°) in left THA and 22.01 (22.01° ± 6.35°) in right THA (p < 0.001). The mean abduction was 37.50 (37.50° ± 6.76°) in left THA and 38.59 (38.59° ± 6.84°) in right THA (p = 0.011). In the left side, the cup was positioned in Lewinnek’s safe zone in 52% for anteversion, 87% for abduction, and 46% for both anteversion and abduction. But the cup placement within Lewinnek’s safe zone was 71, 88, and 62% in the right side, respectively. There were significant differences in the percentage of acetabular cup placement within the safe zone for anteversion (p < 0.001) and for both anteversion and inclination (p < 0.001). Dislocation occurred in 7.0% (35/498) of cases in left THA and 3.2% (16/498) in right THA. The percentages of patients experiencing dislocation were significantly different between the two sides (p = 0.006).ConclusionsThis current study demonstrated that surgeon handedness is likely to be a contributing factor that affects cup inclination and anteversion in bilateral THA and that the placement of cup performed by dominant hands of surgeons is more accurate than that performed by non-dominant sides.

Treatment of Lumbar Spinal Stenosis by Microscopic Unilateral Laminectomy for Bilateral Decompression: A Technical Note.

Lumbar spinal stenosis is typically a degenerative condition that leads to compression of the spinal canal and lateral recess, resulting in leg pain and walking disability. Surgical management is indicated after failure of non-surgical management or rapidly worsening neurological impairment. The traditional approach is a laminectomy with foraminotomy and partial facetectomy but a newer minimally invasive option, unilateral laminectomy for bilateral decompression (ULBD), seems to demonstrate the better postoperative outcomes due to its unilateral exposure. ULBD involves a midline incision, opening the thoracolumbar fascia, retracting the paravertebral muscles unilaterally, then a hemilaminectomy, flavectomy, and decompression of the spinal canal with foraminotomy or partial facetectomy. The clinical decision on which side to approach spinal stenosis with ULBD has not been discussed in the literature. We have come up with an algorithm to decide which side to approach for ULBD based on position of spinous process and angulation, side of maximal compression, and surgeon handedness.

Risk factors for tibial implant malpositioning in total knee arthrosplasty-consecutive series of one thousand, four hundred and seventeen cases.

Total knee arthroplasty (TKA) malalignment may result in pain and limited range of motion. The present study assessed the influence of different surgeon's and patient's related factors on the post-operative tibial tray coronal alignment. The charts and the x-rays of a continuous prospective series of 1417 TKAs operated upon between 1987 and 2015 were retrospectively reviewed. The long-leg AP views were performed at twomonths post-op and the tibial mechanical angle of the tibial tray was measured. Three groups were defined: varus (≤87° n = 167), valgus (≥93° n = 55) and well alignment (88° to 92° n = 1195). The influence of several pre-operative and peri-operative factors was investigated: surgeon handedness and experience (junior or senior), previous tibial osteotomies, Ahlbäck stage of osteoarthritits, pre-operative alignment, height and weight, age at surgery, approach (medial, lateral or tibial tubercle osteotomy), generation of implants, tray fixation, size of the tray and stem lenght. Univariate then multivariate analysis were performed to find out any correlation. Multivariate analysis showed a strong correlation between varus alignment of the tibial tray and pre-operative varus of the lower limb (p = 0.037), increased BMI (p = 0.016) and operated side opposite to the dominant surgeon's arm (p = 0.006). In a similar way a strong correlation was found between valgus alignment and pre-operative valgus of the limb (p = 0.026). Poor alignment of the tibial tray after TKA was associated with pre-operative malalignment of the lower limb, increased BMI and an index knee which was opposite to surgeon's dominant arm.

Optimisation of a laparoscopic tool handle dimension based on ergonomic analysis

The techniques of Minimally Invasive Surgery (MIS) have quickly entered everyday surgical practice, and are steadily displacing traditional procedures. The reason is the advantages they have for the patient, both during surgery and in postoperative recovery. However, poor ergonomic design of the instruments used in MIS causes surgeons muscle fatigue and injuries (such as paraesthesia, etc.), forcing them to refrain from performing operations for several days or even weeks, which supposes costly losses of time and money.The objective of the present study was to optimize the handle size of a laparoscopic grasper tool. The study was conducted with the participation of 135 surgeons. Each participant performed a series of trials in which they executed the same action several times with the same tool (same in terms of the geometrical form of the handle) but of different dimensions (size) in order to determine the optimal diameter. The results were then subjected to a statistical analysis to study the relationship between the size of the surgeon's hand and the perceived optimal diameter of the handle from an ergonomic point of view.There stands out among the conclusions drawn from the study that there is indeed a relationship between the size of a surgeon's hand and the optimal handle size for them to use in surgery. In this sense, one of the most relevant results is that it is necessary to consider four different handle sizes groups (XS, S, M and L) instead of the three groups proposed by Greiner (1991). Another interesting result is that all surgeons in the smallest handle size group (XS) were women, and in the L group were men. Also it was interesting to note that, for the intermediate hand sizes (S and M), the sex of the surgeon conditioned the optimal handle size, and that the surgeon's experience and surgeon's handedness were not factors affecting the optimal diameter of the handle. Relevance to industryThe results of this work can assist designers of grasping tools in developing better handles and provide required sizing for improved comfort, performance and lowering the risk of cumulative traumatic disorders. It is important to note that it is not necessary to design the handle of the grasper tool for each surgeon hand, but also with four hand size categories is possible to offer an appropriate handle size for all surgeons independently of their hand sizes.

The impact of surgeon handedness in total hip replacement.

Total hip replacement (THR) is successful and performed commonly. Component placement is a determinant of outcome. Influence of surgeon handedness on component placement has not been considered previously. This study was a radiographic assessment of component positioning with respect to handedness. Early data from 160 patients are reported. Overall, 160 primary THRs for osteoarthritis were included. Equal numbers of left and right THRs were performed by four surgeons, two right-handed and two left-handed. Postoperative radiography was assessed for THR component position by measurement of leg length inequality, acetabular inclination and centre of rotation. Surgeons' handedness was assessed using the Edinburgh inventory. For leg length inequality, no significant interaction was seen between hip side and surgeon handedness. Acetabular inclination angles showed a statistically significant difference, however, depending on hand dominance, with higher inclination angles recorded when operating on the dominant side. There was a trend towards greater medialisation of the centre of rotation on the non-dominant side although this did not reach statistical significance. Surgeon handedness appears to influence acetabular component position during THR but it is one factor of many that interact to achieve a successful outcome.