Left-handedness--a handicap for training in surgery?

Effect of Laterality in Microsurgery: Comparative Study of an Expert and a Novice

Background: Hand laterality has an impact on surgical gestures. In this study, we sought to measure the multi-parameter variability of the microsurgical gesture depending on the hand used and the differences between expert microsurgeons and novices. Methods: Ten experienced microsurgeons and twenty medical students with no prior microsurgical experience performed arterial anastomosis on a chicken wing artery using dominant and non-dominant hands. We measured time and force using a homemade force-sensing microsurgical needle holder, heart rate variability with a Polar H10 chest strap, anxiety with the STAI-Y questionnaire and anastomosis quality using the MARS 10 scale. Results: In the microsurgeons' group, duration of anastomosis (p = 0.037), force applied to the needle holder (p = 0.047), anxiety (p = 0.05) and MARS10 (p = 0.291) were better with the dominant hand. For novices, there was no difference between the dominant and non-dominant hand pertaining to force, time and stress level. There were no differences between microsurgeons and novices pertaining to force and anxiety using the non-dominant hand. Conclusions: The study highlighted a marked laterality among microsurgical experts, a finding that may be explained by current learning methods. Surprisingly, no laterality is observed in students, suggesting that for a specific gesture completely different from everyday tasks, laterality is not predefined. Ambidexterity training in the residency curriculum seems relevant and may help microsurgeons improve performance and postoperative outcomes.

Left-handedness in otolaryngology, who is right?

Objectives

This study aimed to ascertain the prevalence of left-handedness (LH) among otolaryngology-head and neck surgery (ORLHN) practitioners, investigate dexterity's impact on LH trainees, and identify common patterns in their training to improve the training experience.

Methods

A web-based survey was distributed anonymously via email to members of the Saudi Otorhinolaryngology Society. The survey targeted ORLHN attending consultants, board-certified registrars, and current residents. It consisted of three sections: the first focused on the experience of attending consultants in training LH individuals, the second investigated common maneuvers employed by rhinologists, and the third explored the experiences and impacts reported by LH trainees.

Results

The study included 174 participants, and found a 13.2% LH prevalence among them. Rhinologists showed disparities, with 50% advising trainees to stand on the left side of the bed and use their left hand for the scope, whereas the other half asked otherwise. Additionally, 94.4% of the participants had not encountered any courses specifically tailored for LH trainees. Among LH trainees, 57% and 41% reported difficulties in learning and performing side-specific procedures such as functional endoscopic sinus surgery and endoscopic septoplasty, respectively, often attempting to switch to their nondominant hand, and feeling disadvantaged due to their laterality.

Conclusions

Left-handedness presents challenges for both LH trainees and their trainers in surgical specialties, particularly in ORLHN, in which specific positioning and instruments are crucial to gain access to the desired surgical field. Despite these challenges, there is insufficient support for LH individuals. We recommend encouraging LH trainees to openly disclose and discuss their left-handedness, provide them with mentors, establish standardized operating room setups and techniques, supply appropriate instruments, and demonstrate flexibility in accommodating their needs.

Level of evidence

Level 5.

Left-Handed Palming of the Needle Driver: A Technical Report for Surgical Trainees

Left-handed surgical trainees are uniquely challenged when learning how to suture using standard needle drivers designed for right-handed individuals and often feel disadvantaged in comparison to their right-handed peers. "Palming," a suturing technique that improves suturing mechanics and efficiency, cannot be achieved in the standard manner using the left hand. This paper proposes a previously undescribed technique for palming using the left hand that provides many of the same benefits as standard palming methods using the right hand, potentially reducing a common source of inequity in surgical training.

Laterality and otorhinolaryngology: a review

BACKGROUND

Laterality of paired organs involves the function of the eyes, ears, hands and feet. Whilst most people have a right-handed preference, about 10 per cent are left-handed. Similarly, the right eye is usually preferred to the left. Medicine is both taught and practised for those with right hand and eye preference, and left-handed medical students and doctors must negotiate the right-handed world.

OBJECTIVE

This brief review looks at society's attitudes, medical training and the practice of otolaryngology in the UK towards laterality and handedness.

METHOD

Literature review.

RESULTS

Studies suggest that left-handers are more versatile and so are more ambidextrous. Conversely, this may result in problems when a right-hander tries to undertake a procedure with the non-dominant hand.

CONCLUSION

Cultures and attitudes are changing towards those who are left-handed. Left-handed surgeons may encounter difficulties in the clinical environment throughout their training.

Left-Handedness in Obstetrics and Gynecology: A Nationwide Survey of U.S. Trainees and Educators

OBJECTIVE

This study aimed to evaluate the views and influence of left-handedness among obstetrics and gynecology (OBGYN) trainees and educators and to identify perceived obstacles in training by left-handed (LH) trainees.

STUDY DESIGN

An online survey was sent to the U.S. Obstetrics and Gynecology training programs. All participants were asked questions on hand preference for various medical and nonmedical activities, as well as on demographics. Participant responses to handedness and their role as a learner or educator directed them toward further questions. Trainees were surveyed on their experience and outlook as a LH physician in OBGYN. Educators were surveyed on their experience and attitudes in working with LH trainees. LH educators were also surveyed on their experience as a LH physician, similar to the LH trainees. Chi-square or Fisher's exact analysis was used as appropriate, with p-value <0.05 considered statistically significant.

RESULTS

Responses were received from 21 training programs, totaling 304 individuals. Participants included 205 learners (156 right handed and 49 left handed), and 99 faculty (82 right handed and 17 left handed). A lack of LH surgical instrument availability (93.6%) and difficulty using right-handed (RH) instruments (83%) were notable obstacles reported by LH learners. The majority of LH learners (57.4%) did not consider their handedness to be disadvantageous but did note added difficulty when training under RH mentors when compared with training under LH mentors (66%). In contrast to LH educators, RH educators endorsed added difficulty in instructing operative procedures to LH learners (32.1 vs. 13.3%, p = 0.012).

CONCLUSION

LH trainees face unique challenges during their OBGYN training. Educators would benefit from guidance on how best to manage these trainees. Educators should work to adapt surgical and procedural techniques to accommodate LH trainees.

KEY POINTS

· LH learners reported more difficulty in training under RH mentors.. · RH mentors reported increased difficulty in educating LH trainees.. · Neither trainees nor educators considered being LH a significant disadvantage..

Issues and Strategies in Training Left-Handed Surgeons

Left-hand dominance in surgery is a trait historically regarded as disadvantageous to both the trainee and trainer. The aim of this editorial was to identify challenges faced by left-handed trainees and trainers across multiple surgical specialties and to propose strategies that could be implemented during surgical training. Multiple themes were identified including left-handed surgeons experiencing discrimination due to their handedness. Additionally, a higher incidence of ambidexterity among left-handed trainees was noted, suggesting that left-handed surgeons may be adapting to a lack of accommodations for left-hand trainees. Also explored were the effects of handedness in training vs practice and the effects of handedness across subspecialties including orthopedic surgery, cardiothoracic surgery, and plastic surgery. Solutions discussed involved teaching both right-handed and left-handed surgeons' ambidexterity, pairing left-handed surgeons with left-handed trainees, having left-handed instruments available, adapting the surgical environment to the operating surgeon, communicating laterality, utilizing simulation centers or virtual reality, and encouraging prospective research looking at best-practices.

The Right Way to Teach Lefties - Exploring the Experiences of Left-Handed Trainees and Surgeons

OBJECTIVE

This study describes the educational experiences of left-handed (LH) surgeons and provides recommendations for educating LH trainees, who face challenges due to their handedness.

DESIGN, SETTING, AND PARTICIPANTS

A mixed methods analysis was performed. Semi-structured interviews were conducted with LH trainees, LH attendings, and right-handed (RH) attendings representing 4 hospitals within a large academic hospital system. Questions were curated from current literature to explore the educational experiences of LH trainees. Inductive and iterative coding techniques were employed to manually generate themes. Laterality questionnaires for skills in daily life and surgery were collected and analyzed.

RESULTS

Laterality questionnaires demonstrate that LH trainees and surgeons are more mixed-handed and use their nondominant hand to a greater extent in surgery compared to daily life than RH attendings. Key themes were identified in the dimension of learning, including that initial decisions for which hand to use remain fixed throughout career, LH learning is largely self-directed, forced conformation to RH norms and microaggressions are common, LH instruments are rarely practical, and LH surgeons are advantaged with situational ambidexterity. Key themes related to teaching include that communication regarding handedness is lacking, RH surgeons are often unaware of/resistant to a LH approach, the onus is on the trainee to suggest accommodations to use their left hand, and attendings rarely effectively mentor LH learners in using their left hand.

CONCLUSIONS

Left-handed surgeons face challenges in an environment designed for RH individuals, represented by themes regarding learning and teaching experiences of LH surgeons told by themselves and their teachers. Recommendations were created for LH trainees in learning, all attendings in teaching, LH attendings in their opportunity to mentor, and surgical societies in supporting LH trainees. Development of resources for LH trainees could fill a substantial gap. Exploration of how LH surgeons evolve situational ambidexterity could benefit all surgeons.

Simulated skill complexity and perceived cognitive load during preclinical dental training

INTRODUCTION

Cognitive Load theory (CLT) focuses on the information processing aspect of learning and how the working memory handles the mental effort associated with new task. The aim of this study is to investigate the association between the perceived cognitive load and performance amongst dental students during preclinical simulation training at various levels of procedural task complexity. Additionally, some cognitive load-modifying factors were examined.

MATERIALS AND METHODS

This cross-sectional study evaluated the perceived cognitive load amongst second-year dental students (n = 34), using the validated National Aeronautics and Space Administration's Task Load Index (NASA TLX index) after training on four dental tasks at two levels of complexity, in addition to structured online anonymous questionnaire about demographics, feedback and performance. The NASA TLX raw scores and the weighted global score were calculated for each exercise. Descriptive statistics and Pearson's correlations between performance and the corresponding NASA TLX-weighted score were calculated. Mean differences in the perceived cognitive load across the exercise levels were assessed using RM-ANOVA with Bonferroni corrections at p < .05.

RESULTS

Reduced performance was significantly associated with higher cognitive load particularly in high complexity dental task (class II-mirror vision). Simulated exercise complexity significantly influenced the students' perceived mental demand, physical demand and temporal demand; all were significantly higher for class II- mirror vision task than for direct vision tasks. The majority of participants (82.1%) preferred detailed feedback from instructors, and more than half of the participants (60.7%) preferred continuous feedback throughout the training session.

CONCLUSION

Complex dental tasks are associated with higher cognitive load in novice dental students during preclinical training. The NASA TLX index is a useful instrument to explore the level of perceived cognitive load associated with performance of simulated complex dental skills. Cognitive load theory is relevant to simulation-based dental education to improve the preclinical instructional efficiency and to enhance students learning.

The Sinister Surgeon: Advanced Pediatric Minimally Invasive Surgery for Left-Handed Surgeons

Purpose: Left-handed (LH) surgeons face unique challenges in their training and practice. Contrary to the historical and unjust perception of technical inferiority, LH surgeons can thrive under appropriate mentorship and support. Here, we describe modifications to pediatric minimally invasive surgeries to benefit the LH surgeon. Methods: The surgical approaches to common and complex pediatric surgical operations were modified to facilitate training of an LH pediatric surgical fellow. Results: Preoperative preparation, including communication with the operating room team, patient positioning, and provision of appropriate equipment, allowed the procedures to be accomplished in a safe and efficient manner. Conclusions: Modifying complex minimally invasive surgery to allow for use of the dominant hand is feasible and safe.

Comparative effectiveness of telesimulation versus standard simulation for pediatric Minimally Invasive Surgery (MIS) essential skills training

BACKGROUND

Proctored on site simulation-based surgical education has been integrated in our residents curricula since 2012. Due to COVID-19 pandemic and social distance protocols, we developed a Tele-assisted Essential Skills Training Module (T-ESTM). The aim of this study is to evaluate comparative effectiveness between Telesimulation (T) versus Standard Simulation (S) for minimally invasive surgery (MIS) essential skills training.

METHODS

ESTM includes academic lectures, tutorials for ergonomics and 7 hands-on tasks scheduled into 2 sessions of 3 hours. Initial and final assessment scoring (adapted from GOALS) as well as timing for 3 of the tasks were registered. Telesimulation (T) group accessed the content online and completed their Hands-On practice through a digital communication platform. Standard Simulation (S) group attended conferences and Hands-On practice at the simulation center. Both groups were proctored by the same educators with summative and formative feedback and debriefing. Data was analyzed with the R-studio software program.

RESULTS

Each group had 20 participants with a mean age of 28 ± 5 years. 67.5% were surgeons in training, 47.5% had performed low complexity procedures and 40% had previous experience with simulation training. We observed a significant improvement in scoring and time reduction for all assessed tasks in S and T groups (p < 0.001), with no statistically significant differences when comparing both groups. Similar performance could be achieved with both strategies.

CONCLUSION

Telesimulation is a reproducible and effective educational tool for remote MIS essential skills training, and should be considered as an alternative to on-site simulation programs.

LEVEL OF EVIDENCE

Level II.

TYPE OF STUDY

Clinical Research.

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review

Situs inversus (SI) is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs. Since the 1990s, more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy. In these cases, the major problem is to overcome is the left-right condition for right-handed surgeons. Laparoscopic common bile duct exploration (LCBDE), an alternative to treat patients with bile duct stones, has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography. Recent updated meta-analyses revealed that a shorter postoperative hospital stay, fewer procedural interventions, cost-effectiveness, a higher stone clearance rate, and fewer perioperative complications are additional advantages of LCBDE. However, the technique is technically demanding, even for skilled laparoscopic surgeons. Conducting LCBDE in patients with difficult situations, such as SI, is more complex than usual. We herein review published SI patients with choledocholithiasis treated by LCBDE, including our own experience, and this paper focuses on the technical aspects.

Age of the leftie: the lived experience of left-handed surgeons

Background

Left‐handers make up 10%–12% of all surgeons. Surgical education and practice by nature has significant technical demands but there is a paucity of data on left‐handers and training in surgery. The surgical curriculum has no specific salutation or recognition of left‐handers and the contributions and challenges they represent.

Methods

The purpose of the study was to explore, describe and understand the lived experience of left‐handed surgeons in relation to surgical education and training in Australia. Semi‐structured interviews were used to gather in‐depth information relating to the participants' experiences, viewpoints, beliefs and motivations.

Results

The responses of the participants involved were categorized using the data analysis method described by Colaizzi. Seven themes were identified: left‐handed surgeons are universal adapters; left‐handed instruments are not necessary for left‐handed trainees; most left‐handed trainees have experienced discrimination or negativity due to their laterality; ambidexterity is considered an advantage; communicating one's laterality is important; a formal mentoring program is not necessary; and simulation can be a complementary tool for left‐ handed trainees. Being a left‐handed surgical trainee need not be a negative experience.

Conclusion

With appropriate support and teaching, left‐handed trainees can develop into excellent surgeons. The themes from this study can be used by trainees, trainers and Colleges of surgical training to build awareness and optimize the training of future left‐handed surgeons.

Effectiveness of telesimulation for pediatric minimally invasive surgery essential skills training

BACKGROUND

In the context of the COVID-19 pandemic and social distancing rules, access to in-person training activities had temporarily been interrupted, speeding up the implementation of telesimulation for minimally invasive surgery (MIS) essential skills training (T-ESTM, Telesimulation - Essential Skills Training Module) in our center. The aim of this study was to explore the effectiveness of T-ESTM.

METHODS

T-ESTM was scheduled into 2 sessions of 3 h through the Zoom® virtual meeting platform. The academic lectures, the tutorials for box-trainer set-up and 7 performance tasks were accessed through an online campus previous to the remote encounter for personalized guidance and debriefing. Initial (pre-telementoring) and final (post 6-hour telementoring) assessment scoring as well as timing for Task 2 (circle-cutting pattern), 3 (extracorporeal Roeder knot) and 5 (intracorporeal Square knot) were registered.

RESULTS

61 participants were recruited. The mean age was 31±5 years. 65% were surgical residents. 48% performed low complexity procedures. 52% had previous experience with simulation training. In Task 2, there was a 21% improvement in the final score obtained, as well as a significant decrease in time of 33%; in Task 3, there was an increase of 39% in the scoring and a decrease of 49% in the timing; and in Task 5, participants improved their technique a 30% and decreased the performance time a 47%. All the differences were statistically significant.

DISCUSSION

Our data support T-ESTM as a reproducible and effective educational tool for remote MIS essential skills hands-on training.

LEVEL OF EVIDENCE

II.

Correlation of surgical case volume and fellowship training with performance on simulated procedural tasks

BACKGROUND

High-volume and fellowship-trained surgeons have superior outcomes. However, in gynecology, a large proportion of cases are performed by low-volume surgeons. Simulation has been shown to be useful in assessing surgical skill and may be a useful tool in hospital credentialing and maintenance of privileges.

OBJECTIVE

To determine the correlation between a surgical case volume and fellowship training with performance on simulated procedural tasks.

STUDY DESIGN

A total of 108 obstetricians and gynecologists with laparoscopic privileges at 2 academic institutions completed a pre-test survey and performed 3 tasks on the LapSim laparoscopic virtual reality simulator. The pre-test survey inquired about the monthly laparoscopic case volume and prior training. Simulations included a basic skills task (peg transfer) followed by a procedural task (salpingectomy) of 2 difficulty levels (low and moderate). Spearman correlation and Wilcoxon tests were used to determine correlations between the survey responses and performance metrics.

RESULTS

Participants included 67 generalists (62%) and 41 fellowship-trained specialists (38%). There was an observed weak correlation among surgical volume (more than 6 cases per month), time to completion, and the amount of blood loss when performing the low-difficulty level salpingectomy (r=-0.32, P=.0007 and r=-0.29, P=.002, respectively). The economy of movement (instrument path length) was correlated to high surgical volume (r=-0.35, P=.0002). Compared with generalists, surgeons with fellowship training performed tasks faster (410.8 seconds [interquartile range, 309.7-595.2]) vs 530.2 seconds (interquartile range, 406.2-605.0; P=.0009), more efficiently at 6.1 m (interquartile range, 4.8-7.3) vs 8.1 m (interquartile range, 5.8-10.7; P=.0003), and with less blood loss at 21.7 mL (interquartile range, 11.8-37.7) vs 42.9 mL (interquartile range, 18.1-70.6; P=.002). Regarding the case volume and fellowship background, there was no difference in ovarian diathermy damage. In addition, there was no difference among most performance parameters for the peg transfer task and the moderate-difficulty salpingectomy procedure.

CONCLUSION

Surgical experience obtained through higher case volume and fellowship training correlate with higher performance scores during simulated procedural tasks. In a previous study, we found a similar correlation with simulated basic skills tasks. The current study is a continuation of an ongoing quality initiative to establish a summative assessment of laparoscopic surgical skills using virtual reality simulator for the maintenance of credentials among obstetrical and gynecologic surgeons. Future studies will compare the performance metrics from laparoscopic procedures performed on virtual reality simulator with the performance in the operating room and clinical outcomes.

Global versus task-specific postoperative feedback in surgical procedure learning

BACKGROUND

Task-specific checklists and global rating scales are both recommended assessment tools to provide constructive feedback on surgical performance. This study evaluated the most effective feedback tool by comparing the effects of the Observational Clinical Human Reliability Analysis (OCHRA) and the Objective Structured Assessment of Technical Skills (OSATS) on surgical performance in relation to the visual-spatial ability of the learners.

METHODS

In a randomized controlled trial, medical students were allocated to either the OCHRA (n = 25) or OSATS (n = 25) feedback group. Visual-spatial ability was measured by a Mental Rotation Test. Participants performed an open inguinal hernia repair procedure on a simulation model twice. Feedback was provided after the first procedure. Improvement in performance was evaluated blindly using a global rating scale (performance score) and hand-motion analysis (time and path length).

RESULTS

Mean improvement in performance score was not significantly different between the OCHRA and OSATS feedback groups (P = .100). However, mean improvement in time (371.0 ± 223.4 vs 274.6 ± 341.6; P = .027) and path length (53.5 ± 42.4 vs 34.7 ± 39.0; P = .046) was significantly greater in the OCHRA feedback group. When stratified by mental rotation test scores, the greater improvement in time (P = .032) and path length (P = .053) was observed only among individuals with low visual-spatial abilities.

CONCLUSION

A task-specific (OCHRA) feedback is more effective in improving surgical skills in terms of time and path length in novices compared to a global rating scale (OSATS). The effects of a task-specific feedback are present mostly in individuals with lower visual-spatial abilities.

The Left-handed Plastic Surgery Trainee: Perspectives and Recommendations

Left-handed surgeons experience difficulty with tools designed for use in the right hand. The purpose of this study was to examine instrument laterality and to survey the experiences of left-handed plastic surgery trainees.

Left-Handedness Among Orthopaedic Surgeons and Trainees

Background:

The impact of left-handedness on orthopaedic surgeons and trainees has not been well described. We investigated the prevalence and perceived impact of left-handedness among orthopaedic surgeons and trainees.

Methods:

We distributed a survey regarding handedness to active members of the American Orthopaedic Association and the Council of Orthopaedic Residency Directors affiliates, including department chairs, program directors, and residency and fellowship program coordinators. Program coordinators were asked to distribute the survey to their current residents and fellows.

Results:

Of 510 survey respondents, 78 (15%) were identified as left hand dominant (LHD). Regarding scalpel/cautery use, 64% of LHD respondents reported using their left hand primarily and 10% reported using their right hand primarily; 26% of LHD respondents described themselves as ambidextrous in scalpel/cautery use, compared with 4.7% of right hand dominant (RHD) respondents (p < 0.001). Regarding suturing, 53% of LHD respondents reported using their left hand primarily and 38% reported using their right hand primarily; 9.0% of LHD respondents described themselves as ambidextrous when suturing, compared with 1.9% of RHD respondents (p = 0.012). Only 5.1% of LHD respondents reported having received laterality-specific psychomotor training, whereas 17% perceived a need for such training during residency; RHD respondents reported similar rates. Ambidexterity in scalpel/cautery use or suturing among LHD respondents was not associated with the perception that their left-handedness was advantageous. LHD attending surgeons were more likely than LHD trainees to perceive their handedness as advantageous (p = 0.007).

Conclusions:

Fifteen percent of orthopaedic surgeons and trainees who responded to our survey were LHD. LHD respondents reported significantly higher rates of ambidexterity in both scalpel/cautery use and suturing compared with RHD respondents. Ambidexterity was not associated with a self-perception that left-handedness was advantageous. LHD-attending surgeons were significantly more likely than LHD residents/fellows to perceive their left-handedness as advantageous. There may be benefits to pairing LHD residents with LHD faculty surgeons early in their training to provide mentorship and insight regarding performing surgical procedures left handed.

Level of Evidence:

Level IV.

Is Being Left Handed an Advantage toward a Plastic Surgery Residency?

Background:

Left hand dominance is a minority trait historically regarded as disadvantageous for surgeons. Contemporary scientific literature and folklore have shed new light on left handedness as a “boutique trait” and possible marker of gifted and exceptional individuals. Our subjective impression that left handedness is prevalent in the unique field of plastic surgery raised questions regarding the scope and possible causality of this phenomenon.

Methods:

One hundred eleven medical doctors in our medical center filled out a 13-item questionnaire regarding hand dominance, medical speciality, and various creative outlets or hobbies.

Results:

Sixty-four percent of the participating plastic surgeons were left handed (significantly higher than the approximate 12% of the general population; P = 0.007). Many of the left-handed doctors admitted to practicing musical instruments and various arts, crafts, and other hobbies.

Conclusions:

Plastic surgery is a unique profession requiring astute minds capable of creative and “outside-the-box” thinking; traits we have learned in recent decades may be particularly keen in left-handed individuals, perhaps suggest a causal relationship to the conglomeration of a majority of left-handed plastic surgeons.

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 ≥15 years and two with <15 years. 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 15 years of experience and 65 by surgeons with less than 15 years. 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 <15 years of experience (P = .0353, OR = 2.92, 1.06-8.03). Surgeons with <15 years 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 15 years 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.

"I am a lefty in a right-handed world": Qualitative analysis of clinical learning experience of left-handed undergraduate dental students

BACKGROUND

Left-handedness is the preferential use of the left hand in single-handed activities such as writing. There are many studies in the literature on left-handedness in relation to professional sports, medicine and surgery. Although dentistry largely depends on manual dexterity and hand skills, there has been little research to investigate the effect of left-handedness on clinical dentistry, particularly in Australasia.

AIM

To gain an insight into the clinical learning experience of left-handed undergraduate dental students at the Faculty of Dentistry, University of Otago, New Zealand.

METHODS

Purposive sampling of left-handed students was done within the final-year class of undergraduate dental students, and they were invited to participate in a semi-structured group interview to discuss their clinical learning experience at the Faculty. Six participants agreed to participate, and the interview was recorded and transcribed verbatim. Collected data were analysed using a thematic inductive/interpretive analysis approach according to the constructivist grounded theory.

RESULTS

All participants reported having clinical difficulties being left-handed students learning using right-handed equipment. There was a common theme of experiencing hand and wrist musculoskeletal problems as well as feeling of guilt causing patient discomfort during treatment. The majority of participants reported incidents where they were told by their supervisors to learn practising dentistry with their right hand and they felt that little guidance was given on how to operate as a left-handed clinician. All participants perceived that being a left-handed operator affected their efficiency and confidence level in their early clinical years.

CONCLUSION

Left-handed students have a strong sense of adaptability. However, in order to improve the learning experience regardless of the difference in the operator's preference of dominant hand, students should be provided with appropriate equipment such as ambidextrous dental chairs and professional guidance, especially during their early career.

The Right Way to Teach Left-Handed Residents: Strategies for Training by Right Handers

PURPOSE

Left-handed (LH) residents remain underrepresented among surgical trainees, and there are few available data on how best to train them. The challenge is amplified when pairing a LH resident with a right-handed (RH) mentor. This report provides recommendations on how to improve the training of LH surgeons in a safe and effective manner.

METHODS

A comprehensive literature review was performed using different databases and search engines to identify all articles relevant to the training of LH residents.

RESULTS

A total of 40 articles highlighted the challenges for LH surgical residents and RH mentors. Our recommendations are based on the following 4 themes: identifying inherent differences in left vs. RH residents, providing guidance to RH mentors training LH residents, adapting the RH environment to the LH surgeon, and maximizing safety during training.

CONCLUSION

An organized approach needs to be taken in training the LH resident. Changes should be instituted at program-wide and national levels to ensure that the training experience of the sinistral surgical resident is optimized.

The effect of handedness and laterality in a microlaryngeal surgery simulator

PURPOSE

There are no controlled prospective studies evaluating the effect of dominant handedness in left- and right-sided surgery in otolaryngology. Endoscopic microlaryngeal phonosurgery is an ideal procedure to assess technical aspects of handedness and laterality, due to anatomic symmetry. In this study, we analyzed (1) choice of surgical approach and (2) outcomes based on handedness and laterality in a microlaryngeal simulator.

METHODS

Using a validated high-fidelity phonosurgery model, a prospective cohort of 19 expert laryngologists undertook endoscopic resection of a simulated vocal fold lesion. These resections were video-recorded and scored by 2 blinded expert laryngologists using a validated global rating scale, procedure-specific rating scale, and a hand preference analysis.

RESULTS

There were 18 right-handed participants and 1 left-handed. 12 left and 7 right excisions were evaluated. Cronbach's alpha for inter-rater reliability was good (0.871, global scale; and 0.814, procedure-specific scale). Surgeons used their dominant hand 78.9% of the time for both incision and dissection. In cases where the non-dominant hand would have been preferred, surgeons used the non-dominant hand only 36.4% of the time for incision and dissection. Use of the non-dominant hand did not influence global or procedural rating (p=0.132 and p=0.459, respectively).

CONCLUSIONS

In this simulation of microlaryngeal surgery, there were measurable differences in surgical approaches based on hand dominance, with surgeons preferring to cut and perform resection with the dominant hand despite limitations in the instrumentation and exposure. Regardless of hand preference, overall outcomes based on global rating and technique specific rating scales were not significantly different.

Left-handed cardiac surgery: tips from set up to closure for trainees and their trainers

There are certain obstacles which left-handed surgeons can face when training but these are not necessary and often perpetuated by a lack of knowledge. Most have been encountered and overcome at some point but unless recorded and disseminated they will have to be resolved repeatedly by each trainee and their trainers. This article highlights difficulties that the left-hander may encounter in cardiac surgery and gives practical operative advice for both trainees and their trainers to help overcome them.

Left-handed surgical instruments - a guide for cardiac surgeons

For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed surgeon. Although they exist, they are not available in many surgical centres. As a result, most operating theatre staff (including many left-handers) have little knowledge of their value or even application. With specific reference to cardiac surgery, this article addresses the ways in which they differ, why they are needed and what is required - with tips on use.

Clinical psychomotor skills among left and right handed medical students: are the left-handed medical students left out?

BACKGROUND

There is a growing perception that the left handed (LH) medical students are facing difficulties while performing the clinical tasks that involve psychomotor skill, although the evidence is very limited and diverse. The present study aimed to evaluate the clinical psychomotor skills among Right-handed (RH) and left-handed (LH) medical students.

METHODS

For this study, 54 (27 left handed and 27 right handed) first year medical students were selected. They were trained for different clinical psychomotor skills including suturing, laparoscopy, intravenous cannulation and urinary catheterization under the supervision of certified instructors. All students were evaluated for psychomotor skills by different instructors. The comparative performance of the students was measured by using a global rating scale, each selected criteria was allotted 5-points score with the total score of 25.

RESULTS

There were no significant differences in the performance of psychomotor skills among LH and RH medical students. The global rating score obtained by medical students in suturing techniques was: LH 15.89 ± 2.88, RH 16.15 ± 2.75 (p = 0.737), cannulation techniques LH 20.44 ± 2.81, RH 20.70 ± 2.56 (p = 0.725), urinary catheterization LH 4.33 ± 0.96 RH 4.11 ± 1.05 (p = 0.421). For laparoscopic skills total peg transfer time was shorter among LH medical students compared to RH medical students (LH 129.85 ± 80.87 s vs RH 135.52 ± 104.81 s) (p = 0.825). However, both RH and LH students completed their procedure within the stipulated time.

CONCLUSIONS

Among LH and RH medical students no significant difference was observed in performing the common surgical psychomotor skills. Surgical skills for LH or RH might not be a result of innate dexterity but rather the academic environment in which they are trained and assessed. Early laterality-related mentoring in medical schools as well as during the clinical residency might reduce the inconveniences faced by the left-handed medical personnel.