Smoothing the steep microsurgery learning curve: considering alternative suture sizes for early-stage microsurgery training with in vivo rat models

Abstract

Background Laboratory microsurgery training using invivo rat models is essential for clinical operation. However, challenges existin a structured training course when students transition from a non-livingmodel exercise to a living one. In the present article, we first demonstratethis steep learning curve in early-stage microsurgery training. We then proposethe potential solution of using various sizes of sutures for different trainingpurposes. Methods Twoseparate preliminary studies were included. First, we reviewed the records of25 students enrolled in our basic microsurgery training course. Each studentcompleted exercises in a non-living model before graduating to a live animalmodel where their performance on end-to-end arterial and venous anastomoses wasevaluated. Second, we examined the feasibility of different suture sizes in amillimeter microvascular anastomosis. Four groups of identical procedures inrat femoral artery were completed using sutures from 8-0 to 11-0. Patency rateand mean blood flow at 60 min post-op were measured and compared. Results Thirty-minute patency rates for firstarterial and venous anastomoses were 18/25 and 14/25. Those students who hadnon-patent anastomoses spent significantly longer time than those who hadpatent ones ( p <.05). For varioussuture sizes, all groups achieved a 100% patency rate. No significantdifferences were found between the mean blood flow volume at 60 min post-op ( p >.05). Conclusions Steep learning curve existed in the early-stagemicrosurgery training when transitioning from non-living to living exercisemodels. The feasibility of using various suture sizes in millimeter anastomosismay be a potential solution for instructors to ease this steep learning curve. Level of Evidence: Not gradable

Quantification of motion during microvascular anastomosis simulation using machine learning hand detection

“…The stable, economical, and precise hand motion of a surgeon is the product of a complex hands-on learning and training process that begins with teaching by a mentor, which is followed by prolonged periods of both supervised and unsupervised training and culminates in performing the technique in an operating room on a patient. There is a steep learning curve for surgical trainees, 28 who must devote themselves to a new language of minute and precise movements that are usually viewed through an operating microscope, which allows only the instruments, not the whole hands, to be seen.…”