Microsurgery Training: Are the Live Models Era Coming in to the Tail? – A Literature Review

Abstract

Introduction: Microsurgery is a relatively new speciality with steep learning patterns. Before practice in real fields surgeons need adequate training to gain the expertise. Different types of living and non-living simulators are used to gain the efficiency. As the living simulator has issues with complexity, availability, cost, ethical approval and special setting and available resources an alternative less complex, inexpensive, no ethical issues, easily available, effective non-living models are demanded by the trainers. 
 Objective: Review the relevant articles to see the justification of use of live models for microsurgery training and to see is there any alternative non-living model to replace living model.
 Materials and Methods: A PubMed and Google Scholar search for key words ‘(microsurgery) AND (training)) AND (live models)) AND (non-living models)) AND (education)’ were performed in February 2021. Total 422 literatures were found from January 1990 to February 2021. Among them 29 were found relevant with topics. Among them 17 were finally selected for discussion.
 Conclusion: Evidences showed non-living low fidelity models are as effective as high fidelity living model in microsurgery training. Many of the studies with ex vivo models have showed promising results which support replacement of live models in basic and intermediate courses. However, those are not sufficient to support for total ban of live models specially in advance microsurgery courses. We are hoping, in near future some blended non-living models may come up using digital or virtual reality technology which can replace the live model era. Further research with highest level of evidences are required.

Enhancing microsurgical skills in neurosurgery residents of low-income countries: A comprehensive guide

“…Establishing an affordable microsurgery laboratory in lowincome countries presents numerous challenges due to limited resources and financial constraints. Hosain [16] reported that "the ideal training model should be without ethical issues, realistic, inexpensive, easily available, and similar or close to the clinical setting. " Many authors have shown the importance of cadaveric studies to improve the understanding of neuroanatomy and neurosurgical approaches.…”

“…Establishing an affordable microsurgery laboratory in low-income countries presents numerous challenges due to limited resources and financial constraints. Hosain[ 16 ] reported that “the ideal training model should be without ethical issues, realistic, inexpensive, easily available, and similar or close to the clinical setting.” Many authors have shown the importance of cadaveric studies to improve the understanding of neuroanatomy and neurosurgical approaches. [ 4 ] It should be noted that the title of this paper mentions “low-resource countries” precisely because many hospitals with low or no resources for microsurgical training are located in low- and middle-resource countries.…”