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J Reconstr Microsurg 2023; 39(07): 517-525
DOI: 10.1055/a-2003-7425
Original Article

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

Ruvi Chauhan 
1   Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Christopher Ingersol
1   Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
William A. Wooden
1   Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Gayle M. Gordillo
1   Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Dimitrios Stefanidis
1   Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Aladdin H. Hassanein
1   Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Mary E. Lester 
1   Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations Funding All listed authors have nothing to disclose. No funding was received for this article. Microvascular anastomosis kits were obtained through an education grant to Indiana University from Zimmer-Biomet.
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Abstract

Background Microsurgical techniques have a steep learning curve. We adapted validated surgical approaches to develop a novel, competency-based microsurgical simulation curriculum called Fundamentals of Microsurgery (FMS). The purpose of this study is to present our experience with FMS and quantify the effect of the curriculum on resident performance in the operating room.

Methods Trainees underwent the FMS curriculum requiring task progression: (1) rubber band transfer, (2) coupler tine grasping, (3) glove laceration repair, (4) synthetic vessel anastomosis, and (5) vessel anastomosis in a deep cavity. Resident anastomoses were also evaluated in the operative room with the Stanford Microsurgery and Resident Training (SMaRT) tool to evaluate technical performance. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) and Short-Form Spielberger State-Trait Anxiety Inventory (STAI-6) quantified learner anxiety and workload.

Results A total of 62 anastomoses were performed by residents in the operating room during patient care. Higher FMS task completion showed an increased mean SMaRT score (p = 0.05), and a lower mean STAI-6 score (performance anxiety) (p = 0.03). Regression analysis demonstrated residents with higher SMaRT score had lower NASA-TLX score (mental workload) (p < 0.01) and STAI-6 scores (p < 0.01).

Conclusion A novel microsurgical simulation program FMS was implemented. We found progression of trainees through the program translated to better technique (higher SMaRT scores) in the operating room and lower performance anxiety on STAI-6 surveys. This suggests that the FMS curriculum improves proficiency in basic microsurgical skills, reduces trainee mental workload, anxiety, and improves intraoperative clinical proficiency.

Keywords

microsurgery - surgical education - reconstructive surgery - surgical simulation

Presented At

Plastic Surgery the Meeting (ASPS) 2021 on Friday, October 29, 2021 in Atlanta, Georgia.




Publication History

Received: 03 May 2022

Accepted: 30 November 2022

Accepted Manuscript online:
23 December 2022

Article published online:
01 February 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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