Naunheim Matthew R, Le Amanda, Dedmon Matthew M, Franco Ramon A, Anderson Jennifer, Song Phillip C
Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States.
Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States.
Am J Otolaryngol. 2017 Jul-Aug;38(4):472-474. doi: 10.1016/j.amjoto.2017.04.009. Epub 2017 Apr 18.
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.
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.
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).
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.
目前尚无对照性前瞻性研究评估耳鼻喉科手术中优势手在左侧和右侧手术中的作用。由于解剖结构的对称性，内镜下微喉嗓音外科手术是评估优势手和手术侧别技术方面的理想手术。在本研究中，我们分析了（1）手术入路的选择，以及（2）在微喉模拟器中基于优势手和手术侧别的手术结果。
使用经过验证的高保真嗓音外科模型，19名专家级喉科医生对模拟声带病变进行了前瞻性队列内镜切除术。这些切除术进行了视频记录，并由2名不知情的专家级喉科医生使用经过验证的整体评分量表、特定手术评分量表和用手偏好分析进行评分。
有18名右利手参与者和1名左利手参与者。评估了12例左侧和7例右侧切除术。评分者间信度的Cronbach's α良好（整体量表为0.871，特定手术量表为0.814）。外科医生在78.9%的时间里使用优势手进行切开和分离。在本应首选非优势手的情况下，外科医生在切开和分离时仅36.4%的时间使用非优势手。使用非优势手并不影响整体评分或手术评分（分别为p = 0.132和p = 0.459）。
在本次微喉手术模拟中，基于手的优势，手术入路存在可测量的差异，尽管器械使用和暴露存在限制，外科医生仍更倾向于用优势手进行切割和切除。无论用手偏好如何，基于整体评分和技术特定评分量表的总体结果并无显著差异。
