The Effect of Hand Size on Colonoscopic Simulation

Jocelyn Ray, PhD, Jay MacGregor, MD, Alicia J Logue, MD, Joseph Gallagher, MD

Colon and Rectal Clinic of Orlando, Orlando Health, University of Central Florida College of Medicine

INTRODUCTION: Standardization of proficiency and identification of what constitutes an appropriate volume of cases to overcome a significant learning curve for colonoscopic techniques has become of increasing interest to both the surgical and gastroenterology communities. We anticipate that several factors will ultimately be identified in trainees that will influence the ease to which one can achieve reasonable technical efficacy.

A common concern expressed amongst trainees is that the handling of the colonoscope is substantially more difficult for those with small hands, in particular when performing a “one person” technique. This may be of value in the educational environment to ensure that trainees are exposed to an appropriate volume that will most suit their technical needs. The purpose of this study was to ascertain whether there was a difference in colonoscopic task proficiency on a simulator between novices with different hand sizes.

METHODS AND PROCEDURES: Twelve medical students with little to no experience handling a colonoscope were asked to complete a level one colonoscopic simulation on the Simbionix GI Bronch Simulator, using a standard adult colonoscope. Students with small hands (glove size <7; n=6) were compared to those with large hand (glove size =7 or >7; n=6) with respect to time spent to reach the cecum during the simulation. The best of 3 independent trials was used in the comparison. Percentage of time spent in the “pain free” zone and percent time with an “unobstructed view” were also recorded. As a control, participants were also evaluated on their speed of performance in a laparoscopic simulation on the 3D Med trainer using two 5mm endodissect instruments (Tyco Healthcare). Each participant completed a short survey to determine level of training and degree of experience with hand held instruments including the colonoscope.

RESULTS: Those with larger hands (glove size > 7) reached the cecum in a shorter period of time then those students with smaller hands (glove size < 7). In addition, those with large hands performed the simulated colonoscopy with a greater percentage of time with a clear view and less documented pain.

CONCLUSION: The effect of hand-size on colonoscopic proficiency has not been well reported in the published literature. Our data, using colonoscopy simulation with colonoscopically naive students, suggests that hand size effects the time required to reach the cecum, percentage of time with a clear view, and percentage of time in pain.

Session: Poster Presentation

Program Number: P171