A comparison of hand- and foot-activated surgical tools in simulated ophthalmic surgery

Authors: Podbielski DW, Noble J, Gill HS, Sit M, Lam WC.

Publication: Can J Ophthalmol. 2012 Oct;47(5):414-7. doi: 10.1016/j.jcjo.2012.05.003. Epub 2012 Jun 29.



To compare the performance characteristics of hand-activated surgical tools with those of foot-activated surgical tools using a virtual-reality simulator of intraocular surgery.


Prospective, unmasked, interventional cohort study.


Eighteen ophthalmology residents at the University of Toronto.


The EYESi ophthalmic surgery simulator was used for the study. The surgical tool evaluated was a simulation of intraocular forceps activated by either a handpiece or a foot pedal. Each resident completed 2 modules—a dexterity module and a capsulorrhexis/cataract module. Each module was completed 4 times, alternating between the hand-activated forceps and the foot-activated forceps. An overall score was calculated for each task on the basis of the efficiency and accuracy of completion of the task, with 100 representing a perfect score. Overall scores were compared between hand and foot control for both modules.


For the dexterity module, there was no significant difference in the overall scores between the 2 groups (91 ± 6 and 93 ± 6 for the foot- and hand-activated forceps groups, respectively; p > 0.05, t test). For the capsulorrhexis module, overall scores were also similar for both groups, the scores being 50 ± 21 and 53 ± 16 for the foot- and hand-activated forceps groups, respectively (p > 0.05, t test). An exit survey of the study’s participants revealed that subjects did not have a preference for the hand or foot modality of the forceps tool, with 10 preferring the hand-activated forceps tool and 8 preferring the foot-activated tool.


During simulated intraocular surgery, foot- and hand-activated surgical tools appear to have similar performance characteristics and are equally well received by residents.