Download PDF
J Reconstr Microsurg 2022; 38(07): 585-592
DOI: 10.1055/s-0042-1750122
Original Article

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

Filip Dąbrowski
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
,
Piotr Stogowski 
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
,
Jan Białek
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
,
Filip Fliciński
2   Pomeranian Medical University in Szczecin, Department of General and Hand Surgery, Szczecin, Poland
,
Maciej Piotrowski
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
,
Rafał Pankowski
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
,
Marcin Ceynowa
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
,
Marek Rocławski
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
,
Szymon Wałejko
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
,
Tomasz Mazurek
1   Department of Orthopaedics and Traumatology, Medical University of Gdansk, Gdansk, Poland
› Author Affiliations
› Further Information
    Permissions and Reprints

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.

Keywords

microsurgery - microsurgical training - COVID-19 - online training - microvascular anastomosis


Publication History

Received: 01 September 2021

Accepted: 23 April 2022

Article published online:
23 June 2022

© 2022. Thieme. All rights reserved.

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

 

  • References

  • 1 Malik MM, Hachach-Haram N, Tahir M, Al-Musabi M, Masud D, Mohanna P-N. Acquisition of basic microsurgery skills using home-based simulation training: a randomised control study. J Plast Reconstr Aesthet Surg 2017; 70 (04) 478-486
    CrossrefPubMedGoogle Scholar
  • 2 Leung CCM, Ghanem AM, Tos P, Ionac M, Froschauer S, Myers SR. Towards a global understanding and standardisation of education and training in microsurgery. Arch Plast Surg 2013; 40 (04) 304-311
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Acland RD, Russell RC. Practice manual for microvascular surgery. Plast Reconstr Surg 1990; 85 (03) 475
    CrossrefPubMedGoogle Scholar
  • 4 Singh M, Ziolkowski N, Ramachandran S, Myers SR, Ghanem AM. Development of a five-day basic microsurgery simulation training course: a cost analysis. Arch Plast Surg 2014; 41 (03) 213-217
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Shurey S, Akelina Y, Legagneux J, Malzone G, Jiga L, Ghanem AM. The rat model in microsurgery education: classical exercises and new horizons. Arch Plast Surg 2014; 41 (03) 201-208
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 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; 51 (Suppl. 04) S126-S130
    CrossrefPubMedGoogle Scholar
  • 7 Margulies IG, Xu H, Henderson PW. Microsurgery training in the digital era: a systematic review of accessible digital resources. Ann Plast Surg 2020; 85 (04) 337-343
    CrossrefPubMedGoogle Scholar
  • 8 De Ponti R, Marazzato J, Maresca AM, Rovera F, Carcano G, Ferrario MM. Pre-graduation medical training including virtual reality during COVID-19 pandemic: a report on students' perception. BMC Med Educ 2020; 20 (01) 332
    CrossrefPubMedGoogle Scholar
  • 9 Satterwhite T, Son J, Carey J. et al. Microsurgery education in residency training: validating an online curriculum. Ann Plast Surg 2012; 68 (04) 410-414
    CrossrefPubMedGoogle Scholar
  • 10 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
  • 11 Stogowski P, Fliciński F, Białek J, Dąbrowski F, Piotrowski M, Mazurek T. Microsurgical Anastomosis Rating Scale (MARS10): a final product scoring system for initial microsurgical training. Plast Surg (Oakv) 2021; 29 (04) 243-249
    CrossrefPubMedGoogle Scholar
  • 12 Lascar I, Totir D, Cinca A. et al. Training program and learning curve in experimental microsurgery during the residency in plastic surgery. Microsurgery 2007; 27 (04) 263-267
    CrossrefPubMedGoogle Scholar
  • 13 Hui KCW, Zhang F, Shaw WW. et al. Learning curve of microvascular venous anastomosis: a never ending struggle?. Microsurgery 2000; 20 (01) 22-24
    CrossrefPubMedGoogle Scholar
  • 14 Pafitanis G, Cooper L, Hadjiandreou M, Ghanem A, Myers S. Microvascular anastomotic coupler application learning curve: a curriculum supporting further deliberate practice in ex-vivo simulation models. J Plast Reconstr Aesthet Surg 2019; 72 (02) 203-210
    CrossrefPubMedGoogle Scholar
  • 15 Ortiz R, Sood RF, Wilkens S, Gottlieb R, Chen NC, Eberlin KR. Longitudinal microsurgery laboratory training during hand surgery fellowship. J Reconstr Microsurg 2019; 35 (09) 640-645
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Paladino JR, Gasteratos K, Akelina Y, Marshall B, Papazoglou LG, Strauch RJ. The benefits of expert instruction in microsurgery courses. J Reconstr Microsurg 2021; 37 (02) 143-153
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Inoue T, Tsutsumi K, Saito K, Adachi S, Tanaka S, Kunii N. Training of A3–A3 side-to-side anastomosis in a deep corridor using a box with 6.5-cm depth: technical note. Surg Neurol 2006; 66 (06) 638-641
    CrossrefPubMedGoogle Scholar
  • 18 Atlan M, Lellouch AG, Legagneux J, Chaouat M, Masquelet AC, Letourneur D. A new synthetic model for microvascular anastomosis training? A randomized comparative study between silicone and polyvinyl alcohol gelatin tubes. J Surg Educ 2018; 75 (01) 182-187
    CrossrefPubMedGoogle Scholar
  • 19 Stogowski P, Białek J, Dąbrowski F, Mazurek T. Current trends in microsurgical education – review of types of training and skill assessment instruments. Chirurgia Narzadow Ruchu i Ortopedia Polska 2021; 86 (04) 1-5
    PubMedGoogle Scholar
  • 20 Dos Reis JMC, Teixeira RKC, Santos DRD. et al. Novel porcine kidney-based microsurgery training model for developing basic to advanced microsurgical skills. J Reconstr Microsurg 2021; 37 (02) 119-123
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 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
  • 22 Al-Bustani S, Halvorson EG. Status of microsurgical simulation training in plastic surgery: a survey of United States program directors. Ann Plast Surg 2016; 76 (06) 713-716
    CrossrefPubMedGoogle Scholar
  • 23 Evgeniou E, Walker H, Gujral S. The role of simulation in microsurgical training. J Surg Educ 2018; 75 (01) 171-181
    CrossrefPubMedGoogle Scholar
  • 24 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
    PubMedGoogle Scholar
  • 25 Martin JA, Regehr G, Reznick R. et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997; 84 (02) 273-278
    PubMedGoogle Scholar
  • 26 Temple CLF, Ross DC. 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
  • 27 Stogowski P, Anuszkiewicz K. Letter to the editor: “Microsurgical suturing assessment scores: a systematic review.”. Neurosurg Rev 2022; 45 (02) 1809-1810
    CrossrefPubMedGoogle Scholar
  • 28 Grant AL, Temple-Oberle C. Utility of a validated rating scale for self-assessment in microsurgical training. J Surg Educ 2017; 74 (02) 360-364
    CrossrefPubMedGoogle Scholar
  • 29 Mishra D, Nair AG, Gandhi RA. et al. The impact of COVID-19 related lockdown on ophthalmology training programs in India - outcomes of a survey. Indian J Ophthalmol 2020; 68 (06) 999-1004
    CrossrefPubMedGoogle Scholar
  • 30 Chick RC, Clifton GT, Peace KM. et al. Using technology to maintain the education of residents during the COVID-19 pandemic. J Surg Educ 2020; 77 (04) 729-732
    CrossrefPubMedGoogle Scholar
  • 31 Pasricha ND, Haq Z, Ahmad TR. et al. Remote corneal suturing wet lab: microsurgical education during the COVID-19 pandemic. J Cataract Refract Surg 2020; 46 (12) 1667-1673
    CrossrefPubMedGoogle Scholar
  • 32 El Boghdady M, Ewalds-Kvist BM, Alijani A. A review of online platforms in training and surgical education. Eur Surg 2019; 51: 41-48
    CrossrefPubMedGoogle Scholar
  • 33 Evgeniou E, Tsironi M, Riley D. Improving fellowship training in microsurgery: a threshold concepts perspective on the curricula of fellowship programs. J Reconstr Microsurg 2015; 31 (08) 579-589
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Dumestre D, Yeung JK, Temple-Oberle C. Evidence-based microsurgical skills acquisition series part 2: validated assessment instruments–a systematic review. J Surg Educ 2015; 72 (01) 80-89
    CrossrefPubMedGoogle Scholar
  • 35 Chung S-B, Ryu J, Chung Y, Lee SH, Choi SK. An affordable microsurgical training system for a beginning neurosurgeon: how to realize the self-training laboratory. World Neurosurg 2017; 105: 369-374
    CrossrefPubMedGoogle Scholar
  • 36 Chai A, Crank S, Mizen K, Philip J. Low-cost model using a digital microscope for learning, practicing, and maintaining microvascular surgical skills. Br J Oral Maxillofac Surg 2021; 59 (02) 247-248
    CrossrefPubMedGoogle Scholar
  • 37 Pafitanis G, Hadjiandreou M, Miller R. et al. The use of mobile computing devices in microsurgery. Arch Plast Surg 2019; 46 (02) 102-107
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Navia A, Tejos R, Canahuate S. et al. MicrosimUC: validation of a low-cost, portable, do-it-yourself microsurgery training kit. J Reconstr Microsurg 2021; (online ahead of print). DOI: 10.1055/s-0041-1735593.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Ma J, You C, Chen H, Huang S, Ieong C. Cerebellar tonsillectomy with suboccipital decompression and duraplasty by small incision for Chiari I malformation (with syringomyelia): long term follow-up of 76 surgically treated cases. Turk Neurosurg 2012; 22 (03) 274-279
    PubMedGoogle Scholar
  • 40 Chen J, Xun H, Abousy M, Long C, Sacks JM. No microscope? No problem: a systematic review of microscope-free microsurgery training models. J Reconstr Microsurg 2022; 38 (02) 106-114
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Boecker A, Kornmann J, Xiong L. et al. A structured, microsurgical training curriculum improves the outcome in lower extremity reconstruction free flap residency training: the Ludwigshafen concept. J Reconstr Microsurg 2021; 37 (06) 492-502
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Almarghoub MA. A simple and cost-effective method for practicing microsurgery. Plast Reconstr Surg Glob Open 2019; 7 (03) e2146
    CrossrefPubMedGoogle Scholar
  • 43 Balasundaram I, Aggarwal R, Darzi LA. Development of a training curriculum for microsurgery. Br J Oral Maxillofac Surg 2010; 48 (08) 598-606
    CrossrefPubMedGoogle Scholar