Learning curveからみた，微小血管吻合術の習熟─顕微鏡下手術初心者への訓練目標設定の試み─

Abstract

Microvascular anastomosis is a very important technique for cerebrovascular surgeons, and although it is not frequently used, technical failure is unacceptable because of the high risk of morbidity. Therefore, training using simulation models is essential. However, the required training volume has not been fully clarified in previous reports. Hence, determining the minimum training volume required before performing actual bypass surgery may contribute to more efficient training of young neurosurgeons, enabling them to attain technical expertise in a shorter period.The author instructed young residents (postgraduate years 2-3) in microvascular anastomosis with the silicone tube training model. The time required to complete one stitch was measured, and these data were used to generate and study the residents' learning curves.All of our residents achieved a dramatic improvement in dexterity after the initial thirty trials, and the time required to complete one stitch progressively decreased thereafter.Based on the author's training record and the actual time required for suturing a STA-MCA bypass, the goal to be attained on the silicone tube model was calculated to be 1.10 minutes for one stitch. It was presumed that all trainees would attain this goal after 200 to 300 trials.Thus, it is possible for a young neurosurgeon with limited training to acquire the technical skills for microvascular anastomosis within 3 to 6 months with appropriate instruction and continuous training.