Dexterity and the cutting edge

Dr Thomas Stuttaford

Published in The Times, Thursday 2nd December 1999.

It is comparatively easy to assess a surgeon's good sense but much more difficult to judge their cutting skills. Dexterity is becoming even more important with the introduction of minimal-access surgery - "keyhole surgery".

Surgeons are used to feeling, as well as looking, when operating through an open wound. With keyhole surgery they are using very long surgical tools, have no tactile feedback, no sensations from finely honed fingers. They have to rely on a two-dimensional image on a screen, whereas the surgery is being performed in three dimensions. The sensitive hand is a redundant asset.

Last week at the annual general meeting of the Medical Council on Alcohol, Dr Simon Smith of St Mary's Hospital presented the study of a research team into computerised methods of assessing manual dexterity, particularly in relation to minimally invasive surgery.

The team's computer program is able to measure dexterity, and changes to it, when surgeons are tired or after they have consumed alcohol.

The dexterity of six surgeons was assessed after a full nights sleep; after a full night in bed, but with the sleep disturbed by being woken up every three hours and then kept awake for 15 minutes; and after a sleepless night. As expected, dexterity was reduced by disturbed sleep as well as by sleeplessness.

Trainee surgeons participated in a crossover trial. Half of them had drunk to the legal driving limit; half had a placebo. Dexterity was tested before they had alcohol and eight hours later. Soon after drinking many of the dexterity test results reflected the effects of alcohol. Although one hour later most of the test results had improved, the surgeons who had been drinking suffered a loss of the usual increasing efficiency and dexterity after settling into the swing of the operation. This effect lasted for six or more hours and was particularly obvious in left-handed tasks.

Pilots know the bottle-to-throttle time - how soon after drinking their performance is optimum. Now surgeons will have to discover their bottle-to-theatre time.

Hangovers still need to be evaluated.

Information on agencies offering advice, guidance and access to support and treatment for doctors affected by alcohol or other drug misuse are listed on the doctors' use of alcohol page.