Learning microsurgical suturing and knotting techniques: comparative data

Abstract

Correctly performed surgical sutures are the basis of surgical safety. This retrospective survey was conducted among participants (n = 263) taking graduate and postgraduate courses between 2000-2004. Placement of sutures, time to perform knotting, safety of knots, and quality of knot stability were tested. None of the students had been previously instructed in microsurgical techniques. At the beginning of the training program, 90-95% of participants damaged the suturing thread at several places. By the end of the course, knotting times significantly decreased in both groups. Graduates decreased their time from 6.8 +/- 2.34 min to 3.28 +/- 0.71 min (mean +/- standard error of the mean), and postgraduates decreased their time from 5.02 +/- 3.25 min to 1.54 +/- 0.54 min (mean +/- standard error of the mean). In our opinion, "mass training" to teach the basics of microsurgery is not a good approach. Instead, individual training should be provided, as tutors offer invaluable advice, and adjust almost each stitch and knot during teaching sessions.

Validation of microsurgical models in microsurgery training and competence: A review

“…They emphasized the role of individualised tutor-based instructions and corrections and advocate against mass training to teach the basics of microsurgery. 17 The most difficult part of learning microsurgery is achieving the necessary orientation for working under the microscope. The surgical gauze is described as a simple and excellent training model for beginners as the first step in achieving initial dexterity.…”

Clinical and pathological assessment of different suture techniques for microvascular anastomosis in rat femoral artery

“…Suitable suture techniques, which reduce the surgery time and vessel wall trauma with little or no pathological complications, form the basis of surgical safety after microvascular anastomosis and are welcomed by microsurgeons [6]. The conventional interrupted suture technique is considered the gold standard for microvessel anastomosis but has certain disadvantages, such as being time consuming as well as having considerable intimal and medial damage [15].…”

The effect of microsurgical training on novice medical students’ basic surgical skills—a randomized controlled trial

“…1). Simple microsurgical sutures in rubber [26] and silicone tube anastomoses [27] have been validated as valuable training models for microsurgery, confirmed by a recent systematic review [28], and are typically the first step in microsurgery courses [21]. In the latex model, four pieces of 3 by 3 cm squares cut from operating gloves were mounted onto a stable surface.…”