Validation of Tabletop Microscopes for Microsurgery Simulation and Training

Abstract

Oral and maxillofacial surgery residency programs are increasingly adopting microsurgery as a core element of training; however, many barriers exist that limit trainees' proficiency. The purpose of this study was to perform a validation of 2 tabletop microscope simulations for their use as a training tool, which could serve as an affordable, alternative method to traditional microsurgery training methods. A prospective, single-institution, multidepartmental validation study was performed. Two microscopes (monocular digital [DM] and binocular stereo [SM]) were used to perform anastomoses on simulation vessels including a silastic tube and a chicken thigh femoral artery. A microsurgeon panel was selected from a population of microsurgery faculty and fellows at Michigan Medicine (Ann Arbor, MI) to perform the anastomoses. The surgeons each performed 4 anastomoses, using each microscope with each vessel, and subsequently completed a survey evaluating the simulation. Predictor variables were the microscope and the vessel. Primary outcome variable was readiness for use, which was defined as the simulation's ability to incorporate into a microsurgical training curriculum in its current state. Secondary outcome variables included realism, value, usefulness, relevance, difficulty, and cost. Paired t tests were used to compare responses. Alpha was set to 0.05. Seven microsurgeons performed the simulation from the departments of oral and maxillofacial surgery (n=5), plastic and reconstructive surgery (n=1), and otolaryngology (n=1). For readiness, the SM simulation required either no modification (n=4) prior to implementation into a microsurgery curriculum or minimal modification (n=3), compared to the DM simulation which required significant modification (n=4) or extensive modification and re-evaluation (n=3) (P=.002). The SM demonstrated a greater mean realism score than the DM for depth perception (5.00 vs 1.57, P<.001), field of view (4.57 vs 3.57, P=.038), lighting (5.00 vs 4.00, P=.038), and clarity (5.00 vs 3.86, P=.030). There was no statistically significant difference between SM and DM in value, usefulness, relevance, difficulty, or cost. Tabletop microscopes demonstrate considerable promise in the future of microsurgical education. The SM simulation was a realistic simulation that may be ready for use in a microsurgical curriculum. Future studies are required to demonstrate the efficacy of this simulation on microsurgical trainees.