(1)
Newcastle Eye Centre Royal Victoria Infirmary, Newcastle upon Tyne, UK
Electronic Supplementary Material
The online version of this chapter (doi:10.1007/978-3-319-59924-3_7) contains supplementary material, which is available to authorized users.
Palming an instrument is a technique that experienced surgeons use subconsciously. The technique requires the surgeon to reposition and retain an instrument within the grasp of one hand, at the same time freeing up fingers of the same hand to perform other tasks. The reverse technique (i.e. “un-palming” an instrument) is used to reposition and grip the same instrument so that it is ready to use again or hand back to the assistant. Most novice surgeons are not formally taught how to palm, and the skill ends up being self-acquired.
Palming can be used to facilitate smooth transition between certain surgical steps. It cuts down the need to relinquish a pair of forceps and allows the non-dominant hand to act as support for the dominant hand during surgery. It also allows novices to remain focused on certain task and avoid disruption during the process of instrument handling. Finally, reversing the technique allows a palmed instrument to be used again without the requirement to requesting it from the scrub nurse. It is suggested that the surgeon practices this technique in their non-dominant hand before phacoemulsification training. The technique will be referred to in subsequent chapters.
7.1 Palming an Instrument Step-By-Step Instruction
The aim is to manipulate an instrument, for example a pair of forceps, from the primary position of use (Fig. 7.1) to a palmed position (Fig. 7.2).
Fig. 7.1
Forceps held in primary position
Fig. 7.2
Forceps held in palmed position
7.1.1 Step 1
Release lower finger support of the instrument by straightening the middle, ring and little fingers so that the instrument is held only with the thumb and index finger (Fig. 7.3).
Fig. 7.3
Palming step 1—initial position
7.1.2 Step 2
Whilst gently holding the instrument between the thumb and index finger, allow the forceps to slip and rotate downwards, as if the instrument is falling out your grip (Fig. 7.4).
