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

Abstract

Background Repetitive training is essential for microsurgical performance. This study aimed to compare the improvement in basic microsurgical skills using two learning methods: stationary microsurgical course with tutor supervision and self-learning based on digital instructional materials. We hypothesized that video-based training provides noninferior improvement in basic microsurgical skills. Methods In this prospective study, 80 participants with no prior microsurgical experience were randomly divided into two groups: the control group, trained under the supervision of a microsurgical tutor, and the intervention group, where knowledge was based on commonly available online instructional videos without tutor supervision. Three blinded expert microsurgeons evaluated the improvement in basic microsurgical skills in both groups. The evaluation included an end-to-end anastomosis test using the Ten-Point Microsurgical Anastomosis Rating Scale (MARS10) and a six-stitch test on a latex glove. Statistically significant differences between groups were identified using standard noninferiority analysis, chi-square, and t-tests. Results Seventy-seven participants completed the course. Baseline test scores did not differ significantly between groups. After the 4-day microsurgical course, both groups showed statistically significant improvement in microsurgical skills measured using the MARS10. The performed tests showed that data for self-learning using digital resources provides noninferior data for course with surpervision on the initial stage of microsurgical training (7.84; standard deviation [SD], 1.92; 95% confidence interval [CI], 7.25–8.44) to (7.72; SD, 2.09; 95% CI, 7.07–8.36). Conclusion Video-based microsurgical training on its initial step provides noninferior improvement in microsurgical skills to training with a dedicated instructor.

Fundamentals of Microsurgery: A Novel Simulation Curriculum Based on Validated Laparoscopic Education Approaches

“…23 Published models include the use of bead transfer, latex glove, and synthetic tubing (e.g., polytetrafluoroethylene, GorTex, and silastic tubing) to simulate vessels and peripheral nerves. [15][16][17][18][19][20][21][22]26,28,32,[34][35][36]45,51,52 These are effective models in skill development and retention demonstrating construct and content validity with the addition of synthetic-based models having face validity. 24 These models do not depend on use of live or cadaveric tissue and are cost-effective.…”

“…These models can be isolated tasks or incorporated into training curricula using cadaveric models for anastomosis practice. 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Recent developments in microsurgical simulation and education even eliminate the use of a standard operating room microscope and instead incorporate a portable binocular microscope or monocular smartphone technology with video recording and feedback. 35 36 37 Some curricula rely on progression of skills based on learner postgraduate year (PGY), but reported outcomes are often not related to PGY level.…”

“…Recent developments in microsurgical simulation and education even eliminate the use of a standard operating room microscope and instead incorporate a portable binocular microscope or monocular smartphone technology with video recording and feedback. [35][36][37] Some curricula rely on progression of skills based on learner postgraduate year (PGY), but reported outcomes are often not related to PGY level. 12 The International Microsurgery Simulation Society consensus statement in 2020 emphasized the importance of nonbiologic models for instruction and need for objective assessment of trainees.…”

What do we know about treating breast-cancer-related lymphedema? Review of the current knowledge about therapeutic options

“…Currently, developing microsurgery skills seems to be an inherent part of surgical specialization. Studies showed that learning microsurgery on the basic level may be achieved by self-learning, using solely tutorial videos as a guide [99]. This creates a great possibility, especially for young doctors, and contribute to the more common availability of microsurgery procedures.…”

Evaluation of a Microsurgery Training Curriculum

“…Current microsurgical simulation and curricula predominantly [3,4,15] evaluate one aspect; technical performance, including assessment with lower fidelity models on synthetic and ex-vivo tissue, tracking and showing progression with objective assessment tools [16,17]. One study [18] perfused an ex-vivo chicken model with "blue blood" with ICG and experts assessed the patency of the vessel, this provides a high-fidelity model without the use of live animal.…”