Assessment of the microsurgical skills: 30 minutes versus 2 weeks patency

Abstract

The aim of this study is to evaluate the amount of training needed by a trainee, with no background in microsurgery, in order to achieve proper skills for microvascular anastomosis. A protocol based on the rat femoral artery was established to provide a quantitative representation. Five inexperienced subjects started performing microvascular anastomosis. Patency was assessed at 30 min. The final assessment was performed at 2 weeks when rats were reoperated and the patency below the anastomosis was checked. The experiment was discontinued for one subject when he/she succeeded to have two series of four anastomosis with 100% patency at 2 weeks. The results were: 47.5% patency rate at 30 min and 7.5% at 2 weeks (series 1-2); 67.5 and 32.5% (3-4); 82.5 and 35% (5-6); 100 and 70% (7-8); 100 and 87.5% (9-10). Two trainees obtained 100% patency at 2 weeks after series 9-10. Other three needed two more series. There is a significant statistic difference (P < 0.01) between the results at 30 min and 2 weeks for the series (1-2, 3-4, 5-6, 7-8). The patency rate at 2 weeks reflects in a better way the microsurgical skills of a trainee. For long term functioning anastomosis, the training period needs an extension beyond that necessary for 100% patency at 30 min.

Training of microsurgical skills on nonliving models

“…Initial positive results however might not be a sensitive-enough predictor of real life performance, generating the need for significantly longer training (Ilie et al 49 ). The future of microsurgical training courses will therefore belong to successions of focused exercises, which once assembled in continuity reconstruct the real life situations, helping both the transition to human surgery and the replication of favorable results to large series of subjects.…”

Is There Good Simulation Basic Training for End-To-Side Vascular Microanastomoses?

“…Irrespective of the microsurgical technique, whether the purpose of training is to integrate new skills or improve on Fig. 2 Result after microsurgical end-to-side training (diameter = 2.2 mm, magnification 940) and permeability test conducted by injecting water into the earthworm using a syringe existing ones, significant amounts of time must be invested, which conflicts with the constraints faced by residents [13,14]. After extensive training on different animal models such as pigs, rats, rabbits, chicken, and fish [15], and also on discarded abdominoplasty specimens, we have been searching for a new model that can provide a solution to the following issues associated with basic training: ethical rules, cost, time-consuming and expensive anesthesia, and surgical preparation of tissues required to access vessels before performing the microsurgical training, not to mention laboratories that are closed on weekends.…”

Entrenamiento microquirúrgico básico para realizar un modelo animal de alotrasplante compuesto vascularizado

“…Así, se ha sugerido que el entrenamiento microquirúrgico debe empezar en el laboratorio y una vez dominadas las habilidades básicas de microcirugía, dar el paso a la microcirugía clínica. Sin embargo, aún no se ha estandarizado el entrenamiento en el laboratorio, ni la forma de evaluarlo 28,35,37,38 . Si bien creemos que se debe trabajar en este punto, nos parece que la mejor opción es adaptarse a las condiciones locales para lograr adquirir las destrezas básicas de microcirugía.…”

“…Este entrenamiento debe ser estandarizado para poder comparar resultados, la evolución de las habilidades adquiridas y facilitar la enseñanza microquirúrgica. Si bien en nuestro trabajo no se observaron los resultados a mediano plazo como se ha realizado en otros estudios 37 , en todas las anastomosis microvasculares, se evaluó la permeabilidad inmediata y a los 30 min, lo que en general revela cualquier problema mayor en la ejecución de una anastomosis microvascular.…”