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J Reconstr Microsurg 2021; 37(02): 143-153
DOI: 10.1055/s-0040-1715910
Original Article

The Benefits of Expert Instruction in Microsurgery Courses

Joseph R. Paladino
1   Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
,
Konstantinos Gasteratos 
2   Plastic and Reconstructive Surgery Department, Papageorgiou Hospital, Thessaloniki, Greece
,
Yelena Akelina
1   Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
,
Brittany Marshall
3   Department of Biomedical Engineering, Columbia University Irving Medical Center, Columbia University, New York, New York
,
Lysimachos G. Papazoglou
4   Department of Clinical Sciences, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
,
Robert J. Strauch
1   Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
› Author Affiliations Funding This study was funded by an Orthopedic Scientific Research Foundation grant to the Microsurgery Training and Research Laboratory at the Columbia University Irving Medical Center.
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Abstract

Background Microsurgery requires repeated practice and training to achieve proficiency, and there are a variety of curriculums available. This study aims to determine the importance of an expert instructor to guide students through procedures. We compared student proficiency across two microsurgery courses: one with (Columbia University, United States [CU] cohort) and one without a dedicated microsurgery instructor (University of Thessaloniki, Greece [UT] cohort).

Methods Students were divided into two cohorts of 22 students (UT cohort) and 25 students (CU cohort). Student progress was evaluated by examining patency (lift-up and milking tests), anastomotic timing, and quality (Anastomosis Lapse Index [ALI]) of end-to-end arterial and venous anastomoses on day 1 and again on day 5. Chi-squared tests evaluated patency immediately and 30 minutes postoperation. t-Tests evaluated anastomotic timing and ALI scores. p-Values < 0.05 were considered significant.

Results We evaluated progress within and between each cohort. Within the CU cohort, the quality of the arterial and venous anastomosis improved, respectively (by 54%, p = 0.0059 and by 43%, p = 0.0027), the patency of both the arterial and venous anastomosis improved, respectively (by 44%, p = 0.0002 and by 40%, p = 0.0019), and timing of arterial and venous anastomosis reduced respectively (by 36%, p = 0.0002 and by 33%, p = 0.0010). The UT cohort improved the quality of their arterial anastomoses (by 29%, p = 0.0312). The UT cohort did not demonstrate significant improvement in the other above-mentioned parameters. The CU cohort improved materially over the UT cohort across categories of quality, patency, and timing.

Conclusion There are clear benefits of an expert instructor when examining the rate of progress and proficiency level attained at the conclusion of the course. We suggest students who are seeking to maximize proficiency in microsurgical procedures enroll in courses with an expert instructor.

Keywords

anastomosis lapse index - student learning - anastomotic timing - microsurgical training - expert instructor


Publication History

Received: 05 May 2020

Accepted: 15 July 2020

Article published online:
08 September 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Ng ZY. 30th basic instructional course on microsurgery at the Singapore general hospital: a week of self-discovery. Microsurgery 2012; 32 (08) 659-662
    CrossrefPubMedGoogle Scholar
  • 2 Stewart CJ, Yusoff SKM, Widdowson D, Lam WL. Microsurgical skill acquisition in a one-day introductory course with performance evaluation using software-assisted scoring system. J Plast Reconstr Aesthet Surg 2016; 69 (06) 783-788
    CrossrefPubMedGoogle Scholar
  • 3 Gomez M, Nicot C, Verdier J. et al. Does the repetition over a short time of a microsurgical suture improve its reliability?. Hand Surg Rehabil 2019; 38 (06) 348-352
    CrossrefPubMedGoogle Scholar
  • 4 Ghanem A, Kearns M, Ballestín A. et al. International microsurgery simulation society (IMSS) consensus statement on the minimum standards for a basic microsurgery course, requirements for a microsurgical anastomosis global rating scale and minimum thresholds for training. Injury 2020; S0020-1383(20)30078-4. DOI: 10.1016/j.injury.2020.02.004.
    CrossrefPubMedGoogle Scholar
  • 5 MacDonald JD. Learning to perform microvascular anastomosis. Skull Base 2005; 15 (03) 229-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Kim E, Singh M, Akelina Y, Shurey S, Myers SR, Ghanem AM. Effect of microvascular anastomosis technique on end product outcome in simulated training: a prospective blinded randomized controlled trial. J Reconstr Microsurg 2016; 32 (07) 556-561
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Ghanem AM, Hachach-Haram N, Leung CCM, Myers SR. A systematic review of evidence for education and training interventions in microsurgery. Arch Plast Surg 2013; 40 (04) 312-319
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Zheng YD, Nicolas CF, Corvi JJ. et al. Large and uneven bites in end-to-end anastomosis of the rat femoral artery. J Reconstr Microsurg 2020; 36 (07) 486-493
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Harb A, Levi M, Kozato A, Akelina Y, Strauch RJ. Torsion does not affect early vein graft patency in the rat femoral artery model. J Reconstr Microsurg 2019; 35 (04) 299-305
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Levi MA, Harb AA, Nicolas CF. et al. Torsion is tolerated in arterial end to venous side anastomoses in the rat model. J Reconstr Microsurg 2020; 36 (07) 501-506
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Shulzhenko NO, Zeng W, Albano NJ. et al. Multispecialty microsurgical course utilizing the blue-blood chicken thigh model significantly improves resident comfort, confidence, and attitudes in multiple domains. J Reconstr Microsurg 2020; 36 (02) 142-150
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Demirseren ME, Tosa Y, Hosaka Y. Microsurgical training with surgical gauze: the first step. J Reconstr Microsurg 2003; 19 (06) 385-386
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Brosious JP, Tsuda ST, Menezes JM. et al. Objective evaluation of skill acquisition in novice microsurgeons. J Reconstr Microsurg 2012; 28 (08) 539-542
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Cooper L, Sindali K, Srinivasan K, Jones M, Nugent N. Developing a three-layered synthetic microsurgical simulation vessel. J Reconstr Microsurg 2019; 35 (01) 15-21
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Ramachandran S, Ghanem AM, Myers SR. Assessment of microsurgery competency: where are we now?. Microsurgery 2013; 33 (05) 406-415
    CrossrefPubMedGoogle Scholar
  • 16 Sakamoto Y, Okamoto S, Shimizu K, Araki Y, Hirakawa A, Wakabayashi T. Comparative prospective study of microvascular anastomosis training by self-learning or with expert instruction. World Neurosurg 2018; 118: e818-e824
    CrossrefPubMedGoogle Scholar
  • 17 Temple CLF, Ross DCA. A new, validated instrument to evaluate competency in microsurgery: the University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument [outcomes article]. Plast Reconstr Surg 2011; 127 (01) 215-222
    CrossrefPubMedGoogle Scholar
  • 18 Ghanem AM, Al Omran Y, Shatta B, Kim E, Myers S. Anastomosis lapse index (ALI): a validated end product assessment tool for simulation microsurgery training. J Reconstr Microsurg 2016; 32 (03) 233-241
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Microsurgery Training and Research Laboratory.. Columbia orthopedic surgery. Accessed 2019 at: https://www.columbiaortho.org/microsurgery-lab
    PubMedGoogle Scholar
  • 20 Yin X, Ye G, Lu J. et al. A novel rat model for comprehensive microvascular training of end-to-end, end-to-side, and side-to-side anastomoses. J Reconstr Microsurg 2019; 35 (07) 499-504
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Akelina Y, Danilo P. Endogenous adipose tissue as a hemostatic: use in microsurgery. Microsurgery 2008; 28 (03) 192-196
    CrossrefPubMedGoogle Scholar
  • 22 Chan W-Y, Matteucci P, Southern SJ. Validation of microsurgical models in microsurgery training and competence: a review. Microsurgery 2007; 27 (05) 494-499
    CrossrefPubMedGoogle Scholar
  • 23 Grober ED, Hamstra SJ, Wanzel KR. et al. The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures. Ann Surg 2004; 240 (02) 374-381
    CrossrefPubMedGoogle Scholar
  • 24 Brosious JP, Kleban SR, Goldman JJ. et al. Ahead of the curve: tracking progress in novice microsurgeons. J Reconstr Microsurg 2019; 35 (03) 216-220
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Javid P, Aydın A, Mohanna P-N, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: a systematic review. Microsurgery 2019; 39 (07) 655-668
    CrossrefPubMedGoogle Scholar
  • 26 Luther G, Blazar P, Dyer G. Achieving microsurgical competency in orthopaedic residents utilizing a self-directed microvascular training curriculum. J Bone Joint Surg Am 2019; 101 (03) e10
    CrossrefPubMedGoogle Scholar
  • 27 Price J, Naik V, Boodhwani M, Brandys T, Hendry P, Lam BK. A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: the role of deliberate practice. J Thorac Cardiovasc Surg 2011; 142 (03) 496-503
    CrossrefPubMedGoogle Scholar
  • 28 Ilie V, Ilie V, Ghetu N, Popescu S, Grosu O, Pieptu D. Assessment of the microsurgical skills: 30 minutes versus 2 weeks patency. Microsurgery 2007; 27 (05) 451-454
    CrossrefPubMedGoogle Scholar
  • 29 Perez-Abadia G, Janko M, Pindur L. et al. Frankfurt microsurgery course: the first 175 trainees. Eur J Trauma Emerg Surg 2017; 43 (03) 377-386
    CrossrefPubMedGoogle Scholar