Abstract
OBJECTIVES:This study proposed a structured microsurgical training program and evaluated it with the assistance of a large sample of surgeons.METHODS:The practical course comprised 16 sessions of approximately 4 hours each. This included two sessions for suturing rubber gloves and two sessions for suturing arteries, veins, and nerves in chicken thighs. The other sessions were performed on the femoral vessels of rats: 5 sessions for end-to-end arterial anastomosis, 5 for end-to-end venous anastomosis, 1 for arterial grafting, and 1 for end-to-side anastomosis. We conducted a structured assessment of the microsurgical skills in each training session.RESULTS:In this study, 89 surgeons were evaluated. The mean scores for the different procedures were as follows: glove suturing, 33.3±0.59; chicken nerve end-to-end anastomosis, 40.3±0.49; chicken artery suturing, 40.9±0.36; chicken vein suturing, 42.3±0.36; graft interposition, 44.8±0.7; and end-to-side anastomosis, 43.7±0.63 (p<0.05 for all). The chicken thigh suturing scores were significantly higher than the rubber gloves suturing scores (p<0.01). There were no differences between scores of the rat artery and chicken thigh suturing procedures (p=0.24). The rat venous anastomosis scores were higher than the rat arterial anastomosis scores (p=0.02), as were graft interposition scores when compared with end-to-end venous anastomosis scores. The end-to-side anastomosis scores did not differ significantly from the grafting scores (p=0.85). The most common errors were inadequate knotting technique and suture rupture due to inadequate technique (both n=88 [98.9%]).CONCLUSION:We propose a 16-step, progressive microsurgical training program to learn the basic microsurgical techniques comprehensively and reliably. The program was evaluated in a large sample of trainees, and it demonstrated the adequacy of the training sequence and results.
Highlights
Microsurgery is paramount for performing complex reconstructive surgery and is an essential technical skill in many surgical areas
This study proposed a structured microsurgical training program and evaluated it with the assistance of a large sample of surgeons trained at a reference center
Program and participants The Microsurgery Laboratory of our institution has a standard microsurgical training program composed of a theoretical introduction and 16 sessions of practical training
Summary
Microsurgery is paramount for performing complex reconstructive surgery and is an essential technical skill in many surgical areas. Many different standardized microsurgical training programs exist [1,2,3], which should ideally minimize the variations in surgical results. Neuropsychological learning models show that there are substantially different stages in acquiring new knowledge, regarding motor tasks and skills [6,7]. The initial phases are characterized by fast improvement; subsequently, one reaches a plateau, in which there is marginal improvement and task automatization [6,7]. Mokhtari et al [8] demonstrated the existence of plateaus through the 24 microanastomosis sessions using tubes of progressively lower caliber
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