Investigation of Objectivity in Scoring and Evaluating Microvascular Anastomosis Simulation Training

Abstract

The increase in minimally invasive surgery has led to a decrease in surgical experience. To date, there is only limited research examining whether skills are evaluated objectively and equally in simulation training, especially in microsurgery. The purpose of this study was to analyze the objectivity and equality of simulation evaluation results conducted in a contest format. A nationwide recruitment process was conducted to select study participants. Participants were recruited from a pool of qualified physicians with less than 10 years of experience. In this study, the simulation procedure consisted of incising a 1 mm thick blood vessel and suturing it with a 10-0 thread using a microscope. Initially, we planned to have the neurosurgical supervisors score the simulation procedure by direct observation. However, due to COVID-19, some study participants were unable to attend. Thus requiring some simulation procedures to be scored by video review. A total of 14 trainees participated in the study. The Cronbach's alpha coefficient among the scorers was 0.99, indicating a strong correlation. There was no statistically significant difference between the scores from the video review and direct observation judgments. There was a statistically significant difference (p <0.001) between the scores for some criteria. For the eight criteria, individual scorers assigned scores in a consistent pattern. However, this pattern differed between scorers indicating that some scorers were more lenient than others. The results indicate that both video review and direct observation methods are highly objective techniques evaluate simulation procedures.

Evaluation of Ethyl Violet as an Alternative Dye to Crystal Violet to Visualize the Vessel Wall during Vascular Anastomosis

“… 17 ) Further, it is also used as a marker to easily identify the vessel wall torsion, for spraying the subarachnoid space, etc. 1 , 6 , 8 , 16 ) However, there are concerns as regards the risk of allowing these chemicals to remain in the body. 2 , 4 , 15 ) Moreover, the World Health Organization has issued a position statement via the Codex Alimentarius Commission that states the following: “In view of the FAO/WHO Joint Expert Committee on Food Additives conclusions on the available scientific information, there is no safe level of residues of gentian violet or its metabolites in food that represents an acceptable risk to consumers.…”

“… 5 ) CV is useful in the field of neurosurgery, as it is often utilized for visualization of the dissected vessel walls with a diameter of approximately 0.8 mm during vascular anastomosis in pediatric Moyamoya disease. 1 , 6 - 8 ) Moreover, CV is known to have strong bactericidal and antifungal activities against Staphylococcus aureus , including MRSA, and Pseudomonas aeruginosa , although it is reported to be ineffective against Gram-negative bacteria and Mycobacterium tuberculosis . 2 , 9 ) An advantage of using CV is that it has bactericidal and growth-inhibitory activities even at low concentrations and has been observed to be effective against MRSA at concentrations as low as 0.1%.…”