Microsurgical Anastomosis Rating Scale (MARS10): A Final Product Scoring System for Initial Microsurgical Training

Abstract

Background: High cost and ethical controversy of using living models in microsurgical training made non-living models more popular. However, non-living models don’t provide appropriate feedback of microsurgical performance. Currently existing Global Rating Scales used for advanced microsurgical skills validation are difficult to apply on non-living model. This study presents a simple instrument for basic assessment of microsurgical anastomosis on non-living model. Methods: Seventy medical students were divided into 2 groups depending on their prior microsurgical experience. Each participant performed 3 end-to-end anastomoses on chicken femoral artery model. Anastomoses were reviewed by 3 blinded experts and then photographed. Evaluation included a patency tests, longitudinal cut of anastomosis, and the newly proposed tool 10 Point Microsurgical Anastomosis Rating Scale (MARS10). Presented scale consists of 5 factors important for anastomosis closure (anastomosis closure, suture spacing, bites size, knot tying, and cut ends length), graded on 3 point scale (0-2 points). Results were analyzed with analysis of variance, Spearman correlation, and t Student test. Results: Anastomoses evaluated by experts as patent significantly correlated with a high summary score in MARS10 scale (r = 0.73 P < .0001). There was a significant difference in MARS10 score between groups (P < .0001). There were no significant inter-rater differences in scoring among all 3 evaluators (p > .05). Conclusions: 10 Point Microsurgical Anastomosis Rating Scale is a quick, valid, and reliable tool to assess microsurgical end-to-end arterial anastomoses on non-living model.

Video-Based Microsurgical Education versus Stationary Basic Microsurgical Course: A Noninferiority Randomized Controlled Study

“…Next, the anastomotic line, suture placement, vessel tears, partial thickness, and back-wall stitches were evaluated using the Ten-Point Microsurgical Anastomosis Rating Scale (MARS10) ( Table 3 ). 11 Higher MARS10 score corresponded to a better quality of anastomosis with predictive validity of the participants' performance. Each test was meticulously evaluated by three independent experts, who are senior surgeons specializing in microsurgery and microsurgical education.…”

“…23 These include complex methods, such as the Objective Structured Assessment of Technical Skills and University of Western Ontario Microsurgical Skills Acquisition/Assessment Instrument (UWOMSA), to recently published simple scales to perform final product assessments, such as the Anastomosis Lapse Index or MARS10, which allows measuring surgical improvement using nonliving chicken model. 11 24 25 26 27…”

Current trends in microsurgical education – review of types of training and skill assessment instruments

“…There are some scoring systems mainly dedicated to specific training models. Currently, there are only two rating scales that are not related to a particular model and are suitable for assessment on the most of non-living models [26,27].…”

“…The great advantage of this instrument it can be use with success during in-house self-training. Another advantage of MARS10 is that evaluation of the anastomosis can be done remotely by the more experienced surgeon through the photo of the external and internal part of the vessel after cutting it open [26].…”

“…It is important to note that for that reason those scales should be used only for the evaluation of technical aspects of anastomosis performance. Prediction of anastomosis success/failure based on those instruments should be avoided [26,27].…”