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Chou DW, Annadata V, Willson G, Gray M, Rosenberg J. Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review. Laryngoscope 2024; 134:2568-2577. [PMID: 37947302 DOI: 10.1002/lary.31178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Augmented reality (AR) and virtual reality (VR) are emerging technologies with wide potential applications in health care. We performed a scoping review of the current literature on the application of augmented and VR in the field of facial plastic and reconstructive surgery (FPRS). DATA SOURCES PubMed and Web of Science. REVIEW METHODS According to PRISMA guidelines, PubMed and Web of Science were used to perform a scoping review of literature regarding the utilization of AR and/or VR relevant to FPRS. RESULTS Fifty-eight articles spanning 1997-2023 met the criteria for review. Five overarching categories of AR and/or VR applications were identified across the articles: preoperative, intraoperative, training/education, feasibility, and technical. The following clinical areas were identified: burn, craniomaxillofacial surgery (CMF), face transplant, face lift, facial analysis, facial palsy, free flaps, head and neck surgery, injectables, locoregional flaps, mandible reconstruction, mandibuloplasty, microtia, skin cancer, oculoplastic surgery, rhinology, rhinoplasty, and trauma. CONCLUSION AR and VR have broad applications in FPRS. AR for surgical navigation may have the most emerging potential in CMF surgery and free flap harvest. VR is useful as distraction analgesia for patients and as an immersive training tool for surgeons. More data on these technologies' direct impact on objective clinical outcomes are still needed. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2568-2577, 2024.
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Affiliation(s)
- David W Chou
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vivek Annadata
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gloria Willson
- Education and Research Services, Levy Library, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mingyang Gray
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Rosenberg
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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de Menezes BF, Magnani LV, Fernandes MS, Brunello LFS, de Souza TF, Viterbo F. A microscope in your pocket: can smartphones be used to perform microsurgery? Acta Cir Bras 2024; 39:e392524. [PMID: 38808818 PMCID: PMC11126305 DOI: 10.1590/acb392524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/02/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE To evaluate the use of the latest generation smartphone camera in performing arterial microanastomosis in rats. METHODS Ten Wistar rats were divided into 2 groups and underwent anastomosis of the right carotid artery with the aid of magnification from a microscope (group M) and a smartphone camera (group S), to compare patency in 72 hours, as well as to measure the weight of the animals, diameter of the carotid arteries and anastomosis time. RESULTS There was no statistical difference between the weight of the animals or the diameter of the carotid arteries. There was a statistical difference for the time spent on anastomoses, which was greater in group S, with higher rates of thrombosis (p < 0.05). CONCLUSIONS Although our patency and anastomosis time results were statistically lower in the smartphone group, there was success in some cases. As the segment continues to progress, it is likely that the results will improve in line with the evolution of camera technology.
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Affiliation(s)
| | | | | | | | | | - Fausto Viterbo
- Universidade Estadual Paulista – Faculdade de Medicina – Botucatu (SP), Brazil
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Cui L, Han Y, Liu X, Jiao BL, Su HG, Chai M, Chen M, Shu J, Pu WW, He LR, Han YD. Innovative Clinical Scenario Simulator for Step-by-Step Microsurgical Training. J Reconstr Microsurg 2024. [PMID: 38190988 DOI: 10.1055/a-2240-1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Microsurgical training should be implemented with consideration of operative difficulties that occur in actual clinical situations. We evaluated the effectiveness of a novel clinical scenario simulator for step-by-step microsurgical training that progressed from conventional training to escalated training with additional obstacles. METHODS A training device was designed according to multiple and intricate clinical microsurgery scenarios. Twenty surgical residents with no experience in microsurgery were randomly assigned to either the control group (conventional training curricula, n = 10) or the experimental group (step-by-step training courses, n = 10). After 4 weeks of laboratory practice, the participants were scheduled to perform their first microvascular anastomoses on patients in an operating room. The Global Rating Scale (GRS) scores and operative duration were used to compare microsurgical skills between the two groups. RESULTS There were no significant differences in the participants' baseline characteristics before microsurgical training between the groups with respect to age, sex, postgraduate year, surgical specialty, or mean GRS score (p < 0.05). There were also no significant differences in recipient sites between the two groups (p = 0.735). After training, the GRS scores in both groups were significantly improved (p = 0.000). However, in the actual microsurgical situations, the GRS scores were significantly higher in the experimental than control group (p < 0.05). There was no significant difference in the operative duration between the two groups (p < 0.13). CONCLUSION Compared with a traditional training program, this step-by-step microsurgical curriculum based on our clinical scenario simulator results in significant improvement in acquisition of microsurgical skills.
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Affiliation(s)
- Lei Cui
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Beijing, China
| | - Yan Han
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, Beijing, China
| | - Xin Liu
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, Beijing, China
- Department of Plastic and Aesthetic surgery, Shaoxing Stomatological Hospital, Shaoxing, Zhejiang Province, China
| | - Bao L Jiao
- Department of Pain Treatment, First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, China
| | - Hong G Su
- Department of Medical Engineering, XuHeRui Technology Co., Ltd., Beijing, China
| | - Mi Chai
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, Beijing, China
| | - Miao Chen
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, Beijing, China
| | - Jun Shu
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, Beijing, China
| | - Wen W Pu
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Beijing, China
| | - Le R He
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Beijing, China
| | - Yu D Han
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, Beijing, China
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Weber M, Backhaus J, Lutz R, Nobis CP, Zeichner S, Koenig S, Kesting M, Olmos M. A novel approach to microsurgical teaching in head and neck surgery leveraging modern 3D technologies. Sci Rep 2023; 13:20341. [PMID: 37990073 PMCID: PMC10663471 DOI: 10.1038/s41598-023-47225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
The anatomically complex and often spatially restricted conditions of anastomosis in the head and neck region cannot be adequately reproduced by training exercises on current ex vivo or small animal models. With the development of a Realistic Anatomical Condition Experience (RACE) model, complex spatial-anatomical surgical areas and the associated intraoperative complexities could be transferred into a realistic training situation in head and neck surgery. The RACE model is based on a stereolithography file generated by intraoperative use of a three-dimensional surface scanner after neck dissection and before microvascular anastomosis. Modelling of the acquired STL file using three-dimensional processing software led to the model's final design. As a result, we have successfully created an economical, sustainable and realistic model for microsurgical education and provide a step-by-step workflow that can be used in surgical and general medical education to replicate and establish comparable models. We provide an open source stereolithography file of the head-and-neck RACE model for printing for educational purposes. Once implemented in other fields of surgery and general medicine, RACE models could mark a shift in medical education as a whole, away from traditional teaching principles and towards the use of realistic and individualised simulators.
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Affiliation(s)
- Manuel Weber
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany.
| | - Joy Backhaus
- Institute of Medical Teaching and Medical Education Research, University Hospital of Würzburg, Würzburg, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
| | - Christopher-Philipp Nobis
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
| | | | - Sarah Koenig
- Institute of Medical Teaching and Medical Education Research, University Hospital of Würzburg, Würzburg, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
| | - Manuel Olmos
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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de Almeida NRC, Braga JP, Bentes LGDB, Lemos RS, Fernandes MRN, Andrade GL, de Araújo VMM, dos Santos DR, Yasojima EY. Low-cost suture simulator to gain basic surgical skills. Acta Cir Bras 2023; 38:e384223. [PMID: 37851786 PMCID: PMC10578102 DOI: 10.1590/acb384223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/23/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To introduce a new low-cost simulation model for training basic surgical skills. METHODS The training model was made from a mixture of 20 g of acetic silicone with 11 g of maize starch. Validation consisted of serial training sessions, evaluating the mean pre- and post-training time and the mean final score according to the global rating scale. RESULTS A decrease in the time required to perform the sutures was observed, comparing the average post and pre-training time of each training day, with a significant correlation between the order of training and the time for performing the simulation. CONCLUSIONS The presented model proved to be capable of simulating the basic suture training skills. It is easy to make, has low cost, and can be easily reproduced in educational institutions.
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Affiliation(s)
| | - Joyce Pantoja Braga
- Universidade Federal do Pará – Faculdade de Medicina – Belém (Pará) – Brazil
| | | | - Rafael Silva Lemos
- Universidade do Estado do Pará – Laboratório de Cirurgia Experimental – Belém (Pará) – Brazil
| | | | - Gabrielly Leite Andrade
- Universidade do Estado do Pará – Laboratório de Cirurgia Experimental – Belém (Pará) – Brazil
| | | | - Deivid Ramos dos Santos
- Universidade do Estado do Pará – Laboratório de Cirurgia Experimental – Belém (Pará) – Brazil
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Youner ER, Chillakuru YR, Xu H, Dedmon M, Labadie R, Djalilian H, Mahboubi H, Westerberg B, Vaisbuch Y, Blevins N, Chen J, Lin V, Joyce MG, Moncada PX, Dabiri S, Gurgel RK, Kouhi A, Monfared AS. Content Validity of a High-Fidelity Surgical Middle Ear Simulator: A Randomized Prospective International Multicenter Trial. Otol Neurotol 2023; 44:903-911. [PMID: 37590880 DOI: 10.1097/mao.0000000000003998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE After demonstration of face validity of a surgical middle ear simulator (SMS) previously, we assessed the content validity of the simulator with otolaryngology residents. STUDY DESIGN Multicenter randomized prospective international study. SETTING Four academic institutions. METHODS Novice participants were randomized into control, low-fidelity (LF), and high-fidelity (HF) groups. Control and LF produced 2 recordings from 2 attempts, and HF produced 4 recordings from 10 attempts, with trials 1, 4, 7, and 10 used for scoring. Three blinded experts graded videos of the simulated stapedectomy operation using an objective skills assessment test format consisting of global and stapedotomy-specific scales. RESULTS A total of 152 recordings from 61 participants were included. Baseline characteristics did not differ significantly between groups. Depending on the step of the operation, inter-rater reliability ranged from 24 to 90%. For LF and HF, years of training was significantly associated with improved scores in certain objective skills assessment test subparts. HF outperformed the control group on stapes and global scores ( p < 0.05). The HF group demonstrated improvement in global score over trials, but plateaued after four trials. Scores varied greatly for participants from different institutions in certain operative steps, such as transecting incudostapedial joints, likely due to differences in instrumentation and time elapsed since manufacture. CONCLUSION Practice with SMS led to better performance in both global and stapes-specific scores. Further studies are needed to examine construct validity and to create otology-appropriate grading systems. Variables like instrumentation and decline in flexibility of the simulator after 12 months greatly affect performance on the simulator.
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Affiliation(s)
- Emily R Youner
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
| | - Yeshwant R Chillakuru
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
| | - Helen Xu
- Department of Otolaryngology, Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Matthew Dedmon
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Robert Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hamid Djalilian
- Department of Otolaryngology-Head and Neck Surgery and Biomedical Engineering, University of California, Irvine, California, USA
| | | | - Brian Westerberg
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yona Vaisbuch
- Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel
| | - Nikolas Blevins
- Department of Otolaryngology, Stanford University, Stanford, California
| | - Joseph Chen
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto
| | - Vincent Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
| | - Morgan G Joyce
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
| | - Paola X Moncada
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
| | - Sasan Dabiri
- Department of Otolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ali Kouhi
- Department of Otolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashkan S Monfared
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
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Donnelly DT, Nicksic PJ, Zeng W, Dingle AM, Poore SO. Evaluation of a Full-Time Microsurgeon Educator on Resident Training, Research Collaboration, and Grant Funding. J Reconstr Microsurg 2023; 39:648-654. [PMID: 37040796 DOI: 10.1055/s-0043-1767678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND The value of a fully trained microsurgeon dedicated to a laboratory setting at an academic institution is largely unknown. Microsurgery training lacks a national standard despite its highly complicated nature. Our study aims to evaluate the impact of a single laboratory-dedicated microsurgeon on the microsurgical training of integrated plastic surgery residents and collaborative efforts in research. METHOD We devised a three-faceted microsurgical training curriculum, including a collaborative multi-institutional microsurgery course, novel high-fidelity simulator models, and a dedicated microsurgeon. We cataloged grant funding achieved through support to other divisions' protocols. Time, in hours, spent on training and the number of anastomoses completed with the microsurgical educator in a laboratory setting over a 4-year period (2017-2021) were evaluated. Resident independence scores were collected from attending microsurgeons to quantify the translation of microsurgical training. RESULTS Purchasing and maintenance costs of rats in our rodent facility decreased by $16,533.60 as 198 rats were replaced by our models. The residents who participated in our novel microsurgical training program were able to independently perform anastomoses in the OR by their postgraduate year 6. Additionally, the surgical support offered by our laboratory-dedicated microsurgeon led to a total of $24,171,921 in grant funding between 2017 and 2020. CONCLUSION Hiring an expert microsurgical educator to train residents in a laboratory has proved promising in accelerating microsurgical mastery. Novel training modules, alternatives to animal models, save resources in housing and animal costs. The addition of a research-oriented-microsurgeon has improved collaborative efforts to advance a range of surgical fields.
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Affiliation(s)
- D'Andrea T Donnelly
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter J Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Chauhan R, Ingersol C, Wooden WA, Gordillo GM, Stefanidis D, Hassanein AH, Lester ME. Fundamentals of Microsurgery: A Novel Simulation Curriculum Based on Validated Laparoscopic Education Approaches. J Reconstr Microsurg 2023; 39:517-525. [PMID: 36564048 DOI: 10.1055/a-2003-7425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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.
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Affiliation(s)
- Ruvi Chauhan
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher Ingersol
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - William A Wooden
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gayle M Gordillo
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dimitrios Stefanidis
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aladdin H Hassanein
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary E Lester
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Kondo A, Umezawa H, Fukunaga Y, Oshima A, Higashino T, Ogawa R. Supermicrovascular anastomosis training using chicken wings and colored water. J Plast Reconstr Aesthet Surg 2023; 84:531-536. [PMID: 37421676 DOI: 10.1016/j.bjps.2023.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 07/10/2023]
Abstract
Plastic surgeons require experience in supermicroscopic vascular anastomosis. Herein, we report a simple, rapid, and cost-effective training method using chicken wings and colored water. The avian ventral metacarpal artery was selected for dissection and anastomosis to mimic supermicrosurgery. Over 14 weeks (one anastomosis per day), the ulnar artery in 100 chicken wings was exposed by dissection, cut proximally, and injected with blue food dye-colored water by an inexperienced surgeon. After ligating the artery branches, it was cut and subjected to end-to-end anastomosis. Next, colored water was injected into the ulnar artery to check for suture sufficiency. The vessel was re-dissected to inspect the lumen and sutures qualitatively. Of the 100 wings, the first and last 20 wings' ventral metacarpal artery dissection, anastomosis times, and leakage frequency were compared. Avian ventral metacarpal artery diameter was recorded, and the cumulative anastomosis time where individual anastomosis times started decreasing was determined. Leakage rates before and after this point were compared. The avian ventral metacarpal artery diameter was 0.7-0.8 mm. The last 20 wings had significantly shorter median dissection times (12:27 vs. 17:45 min), anastomosis times (9:02 vs. 12:29 min), and leakage rates (15% vs. 70%); more even stitching and parallel ligature points; and less vessel layer inversion than the first 20 wings. After a cumulative anastomosis time of 10 h 26 min, individual times sharply decreased, and the leakage rate decreased significantly (58.3% vs. 23.8%). The proposed method significantly improved supermicrosurgical anastomosis. Thus, we believe that this method will help surgeons improve their supermicrosurgical skills.
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Affiliation(s)
- A Kondo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
| | - H Umezawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Y Fukunaga
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - A Oshima
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - T Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - R Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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Ghabi A, Sabate Ferris A, Pfister G, Chapon MP, Legagneux J, Harion M, De Geofroy B, Mathieu L. Relevance of a Simulation Model to Microvascular Surgery for Military Surgical Residents. Indian J Orthop 2023; 57:305-309. [PMID: 36777130 PMCID: PMC9880103 DOI: 10.1007/s43465-022-00797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023]
Abstract
Introduction Microsurgical training is an asset for deployed military orthopaedic surgeons who frequently treat hand or nerve injuries in the field. The objective of this study was to evaluate a microvascular surgery simulation model intended to prepare residents prior to their enrolment in conventional microsurgery degree training. Methods An experimental study was conducted to evaluate technical progress and satisfaction of military surgical residents using a model based on Japanese noodles with four tests of increasing difficulty. Objective endpoints included instruments handling, distribution, and quality of stitches, as well as anastomoses duration. Responses to the Structured Assessment of Microsurgery Skill self-assessment questionnaire were also analyzed. Results Nine residents from different specialties participated in the study. Their anastomoses quality and average satisfaction significantly increased between the first and the last session (p < 0.05). Conversely, the average operating time decreased significantly over the sessions (p < 0.001). Conclusion This simulation model seems to constitute a satisfactory initiation to microsurgery and could limit the use of animal models. It could also be included in the continuing education of military surgeons who have an occasional microsurgical practice during deployments.
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Affiliation(s)
- Ammar Ghabi
- Clinic of Orthopaedics and Trauma Surgery, Laveran Military Hospital, 34 Boulevard Laveran, 13013 Marseille, France
| | - Alexandre Sabate Ferris
- Clinic of Orthopaedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Georges Pfister
- Clinic of Orthopaedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
- French Military Hand Surgery Center, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Marie-Pauline Chapon
- Clinic of Orthopaedics and Trauma Surgery, Bégin Military Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - Josette Legagneux
- Microsurgery Laboratory, Surgical School, Agence Générale de Equipements et Produits de Santé-Assistance Publique des Hôpitaux de Paris, 7 rue du Fer à Moulin, 75005 Paris, France
| | - Madeleine Harion
- Clinic of Paediatrics, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Bernard De Geofroy
- Clinic of Orthopaedics and Trauma Surgery, Laveran Military Hospital, 34 Boulevard Laveran, 13013 Marseille, France
| | - Laurent Mathieu
- Clinic of Orthopaedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
- French Military Hand Surgery Center, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
- Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005 Paris, France
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Figols Pedrosa M, Barra Perez A, Vidal-Alaball J, Miro-Catalina Q, Forcada Arcarons A. Use of virtual reality compared to the role-playing methodology in basic life support training: a two-arm pilot community-based randomised trial. BMC MEDICAL EDUCATION 2023; 23:50. [PMID: 36690993 PMCID: PMC9869298 DOI: 10.1186/s12909-023-04029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Virtual reality (VR) is a technology that allows us to replace our real environment with one created with digital media. This technology is increasingly used in the training of healthcare professionals, and previous studies show that the involvement and motivation of students who participate in activities that use VR increases compared to those who undergo training with the traditional methodology. The main aim of the study is to evaluate the learning curve of the students using a VR environment, to evaluate the satisfaction with the training activity and the cost, and to compare them with training that uses role-playing methodology. METHODOLOGY Two-arm community-based randomised trial. The control arm will base the training on the usual role-playing methodology. The second arm or intervention arm will base the Basic Life Support (BLS) training on a VR programme. RESULTS Statistically significant differences are observed in the percentage of correct answers in favour of the group that used VR as a learning methodology in the test taken at the end of the course. These differences disappear when comparing the results of the test performed at six months. The satisfaction rating of the role-playing training activity has a score of 9.37 out of a total of 10 and satisfaction with the VR methodology has a score of 9.72. The cost analysis shows that the cost of training a student by role-playing is 32.5 euros and, if trained by VR, it is 41.6 euros. CONCLUSIONS VR is a tool that allows the consolidation of a greater amount of knowledge in the short term and can be used for situations such as pandemics, where traditional formats are not available. In relation to student satisfaction with the training activity, the rating in both groups is very high and the differences are minimal. The results will be directly applicable to the decision making of BLS training in Central Catalonia in relation to the scheduling of training activities that use the VR methodology in an uncertain environment.
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Affiliation(s)
- M Figols Pedrosa
- Gerència Territorial de La Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - A Barra Perez
- Servei d'Atenció Primària Bages-Berguedà-Moianès, Institut Català de la Salut, Manresa, Spain
| | - J Vidal-Alaball
- Gerència Territorial de La Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Sant Fruitós del Bages, Spain.
- Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain.
| | - Q Miro-Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Sant Fruitós del Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - A Forcada Arcarons
- Gerència Territorial de La Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
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Fernandes MRN, Tramontin DF, Pimentel ALJC, Costa LVPDA, Santana Neto D, Xavier DP, Bentes LGDEB, Santos DRD. Low cost and easy acquisition: corn grain in microsurgery training. Rev Col Bras Cir 2023; 49:e20223217. [PMID: 36629718 PMCID: PMC10578816 DOI: 10.1590/0100-6991e-20223217-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/23/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES develop an easily accessible model for training the initial motor practice in microsurgery using corn kernels. METHODS ten corn kernels (Zea mays) were used. A 7mm longitudinal cut was made on one side of the corn grain. The training consisted of performing 4 simple knots between the edges of the incision, using 10-0 mononylon thread. The parameters analyzed were 1) cost of the model; 2) assembly time of the model test system; 3) time for performing the knots; 4) distance between the knots. RESULTS in all corn kernels tested, it was possible to perform the proposed microsurgical suture training, without any difficulty in the procedure. The average time to perform the 4 knots was 6.51±1.18 minutes. The total cost of the simulator model was R$3.59. The average distance between the knots was 1.7±0.3mm. The model developed from corn grains has an extremely low cost when compared to the use of animals or high-tech simulators. Other advantages are the easy availability of canned corn kernels and the possibility of making more than four knots along the 7mm incision. CONCLUSION the training model developed has low cost, is easy to acquire and viable for training basic manual skills in microsurgery.
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Affiliation(s)
| | | | | | | | - Dário Santana Neto
- - Universidade do Estado do Pará, Laboratório de Cirurgia Experimental - Belém - PA - Brasil
| | - Débora Pinheiro Xavier
- - Universidade do Estado do Pará, Laboratório de Cirurgia Experimental - Belém - PA - Brasil
| | | | - Deivid Ramos Dos Santos
- - Universidade do Estado do Pará, Laboratório de Cirurgia Experimental - Belém - PA - Brasil
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Mullarkey MP, Zeineddine HA, Honarpishesh P, Kole MJ, Cochran J. The chicken wing training model in cerebrovascular microsurgery for the side-to-side bypass. J Clin Neurosci 2022; 106:76-82. [DOI: 10.1016/j.jocn.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/22/2022] [Accepted: 10/01/2022] [Indexed: 11/05/2022]
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Bentes LGDB, Costa LVPD, Pimentel ALJC, Tramontin DF, Lemos RS, Vasconcelos MEDSL, Santos DRD. What came first: the egg or the microsurgery training? An ophthalmic model for developing basic skills in microsurgery. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Seifman MA, Young AB, Nestel D. Simulation in plastic and reconstructive surgery: a scoping review. Simul Healthc 2022. [DOI: 10.54531/hnpw7177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since the origins of surgery, simulation has played an important role in surgical education, particularly in plastic and reconstructive surgery. This has greater relevance in contemporary settings of reduced clinical exposure resulting in limited work-based learning opportunities. With changing surgical curricula, it is prescient to examine the role of simulation in plastic and reconstructive surgery.
A scoping review protocol was used to identify relevant studies, with an iterative process identifying, reviewing and charting the data to derive reported outcomes and themes.
Of the 554 studies identified, 52 studies were included in this review. The themes identified included simulator modalities, curriculum elements targeted and relevant surgical competencies. There was a predominance of synthetically based simulators, targeting technical skills largely associated with microsurgery, paediatric surgery and craniomaxillofacial surgery.
Existing simulators largely address high-complexity procedures. There are multiple under-represented areas, including low-complexity procedures and simulation activities addressing communication, collaboration, management and leadership. There are many opportunities for simulation in surgical education, which requires a contextual appreciation of educational theory. Simulation may be used both as a learning method and as an assessment tool.
This review describes the literature relating to simulation in plastic and reconstructive surgery and proposes opportunities for incorporating simulation in a broader sense, in the surgical curriculum.
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Affiliation(s)
- Marc A Seifman
- 1Plastic, Reconstructive and Hand Surgery Unit, Peninsula Health, Frankston, Australia
| | - Abby B Young
- 1Plastic, Reconstructive and Hand Surgery Unit, Peninsula Health, Frankston, Australia
| | - Debra Nestel
- 2Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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FERNANDES MANUELARODRIGUESNEIVA, TRAMONTIN DANIELAFERREIRA, PIMENTEL ANTÔNIOLEONARDOJATAHICAVALCANTI, COSTA LUÍSVINÍCIUSPIRESDA, SANTANA NETO DÁRIO, XAVIER DÉBORAPINHEIRO, BENTES LÍVIAGUERREIRODEBARROS, SANTOS DEIVIDRAMOSDOS. Baixo custo e fácil aquisição: grãos de milho no treinamento microcirúrgico. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo: desenvolver um modelo facilmente acessível para o treinamento da prática motora inicial em microcirurgia a partir da utilização de grãos de milho. Métodos: foram utilizados dez grãos de milho (Zea mays). Realizou-se um corte longitudinal de 7mm em uma das faces do grão de milho. O treinamento consistiu na realização de 4 pontos simples entre as bordas da incisão, utilizando fio de mononáilon 10-0. Os parâmetros analisados foram 1) custo do modelo; 2) tempo de montagem do sistema de teste do modelo; 3) tempo de realização dos nós; 4) distância entre os pontos. Resultados: em todos os grãos testados foi possível realizar o treinamento de sutura microcirúrgica proposto, sem dificuldade ao procedimento. O tempo médio para a realização dos 4 pontos foi de 6,51±1,18 minutos. O custo total do modelo simulatório foi de R$3,59. A distância média entre os pontos foi de 1,7±0,3mm. O modelo desenvolvido a partir de grãos de milhos apresenta custo extremamente baixo quando comparado ao uso de animais ou de simuladores de alta tecnologia. Outras vantagens são fácil disponibilidade de grãos de milho em conserva e possibilidade de serem realizados mais de quatro pontos ao longo da incisão de 7mm. Conclusão: o modelo de treinamento desenvolvido é de baixo custo, de fácil aquisição e viável para o treinamento de habilidades manuais básicas em microcirurgia.
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SMaRT Assessment Tool: An Innovative Approach for Objective Assessment of Flap Designs. Plast Reconstr Surg 2021; 148:837e-840e. [PMID: 34705793 DOI: 10.1097/prs.0000000000008422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY The teaching and assessment of ideal surgical markings for local flaps required for optimal aesthetic and functional outcomes remain a challenge in the present era of competency-based surgical education. The authors utilized the bilobed flap for nasal reconstruction as a proof of concept for the development of an innovative objective assessment tool based on statistical shape analysis, with a focus on providing automated, evidence-based, objective, specific, and practical feedback to the learner. The proposed tool is based on Procrustes statistical shape analysis, previously used for the assessment of facial asymmetry in plastic surgery. For performance boundary testing, a series of optimal and suboptimal designs generated in deliberate violation of the established ideals of optimal bilobed flap design were evaluated, and a four-component feedback score of Scale, Mismatch, Rotation, and Translation (SMaRT) was generated. The SMaRT assessment tool demonstrated the capacity to proportionally score a spectrum of designs (n = 36) ranging from subtle to significant variations of optimal, with excellent computational and clinically reasonable performance boundaries. In terms of shape mismatch, changes in SMaRT score also correlated with intended violations in designs away from the ideal flap design. This innovative educational approach could aid in incorporating objective feedback in simulation-based platforms in order to facilitate deliberate practice in flap design, with the potential for adoption in other fields of plastic surgery to automate assessment processes.
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Microsurgery Arena: A New Device to Develop Microsurgical Skills. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3782. [PMID: 34667708 PMCID: PMC8517307 DOI: 10.1097/gox.0000000000003782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022]
Abstract
Simulation in microsurgery is an important pillar of training and maintenance of surgical skills. Between learning microsurgical skills and mastering them in clinical practice, the usefulness of low-fidelity simulators for improving microsurgery skills has been well documented. Nowadays the in vivo models represent the gold standard of microsurgical training; however, their use implies difficulties and limitations. We developed a portable, low-cost, and modern device to help trainees to practice at their convenience to maintain their microsurgical suturing skills. By using CAD and 3D printer designs, we developed a "microsurgery trainer" that contains a middle section with eight projections with holes, arranged as a circle. The idea is to pass the microsuture-preferably 7/0 or 8/0 sutures-in a clockwise manner-with the needle passing from "out to in" and "in to out" through each hole. This allows the trainee to use his/her wrist to be flexible and achieve better control over the micro needle. Studies evaluating the potential of such a device in shortening the learning curve are needed and will be crucial to define whether the "microsurgery arena" will help trainees to obtain better outcomes in microsurgical practice.
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Menezes Neto BFD, Oliveira Neto FVD, Secanho MS, Carvalho LB, Moragas WR, Fernandes MS. Submerged vascular anastomosis. A technique for vascular suturing in experimental microsurgery. Acta Cir Bras 2021; 36:e360807. [PMID: 34644775 PMCID: PMC8516427 DOI: 10.1590/acb360807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/24/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: To evaluate the impact of submersion of the microsurgical anastomosis suture
area using saline (0.9% NaCl) in an experimental laboratory during the
training of medical students and resident physicians. Methods: Wistar rats (n = 10) were selected to have the two femoral arteries sectioned
and anastomosed end-to-end under optical magnification. They were randomly
divided, so that on one side suturing was performed under submersion with
saline, and the contralateral side was kept dry during the procedure. The
surgical times, as well as the patency within 30 min and 72 h of the
procedure, were evaluated. Results: Six male Wistar rats survived the surgical anesthetic procedure, with the
average initial weight of 243.3 g and the average artery diameter of 0.86
mm, with average time of 15.67 min for the submerged technique and 20.50 min
for the dry technique (p = 0.03). The failure rates were 17 and 50% for the
submerged group and the dry one, respectively (p = 0.62). Conclusions: Submerged microvascular suture does not compromise the patency of the vessel
or increase the time of anastomosis. Therefore, it is a strategy that can be
applied by the surgeon according to his/her technical preferences.
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Mastering microsurgery: A novel benchmarking tool for microsurgical training. J Plast Reconstr Aesthet Surg 2021; 75:811-816. [PMID: 34753684 DOI: 10.1016/j.bjps.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/19/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVE The shift of surgical training from apprenticeship model towards competency-based training requires objective assessments of microsurgical skills to achieve mastery. Our objective was to create a novel platform to provide feedback to surgical trainees relative to competency expected at their level of exposure. METHODS A 5-day simulated microsurgery course was run between 2013 and 2016 with 118 participants. Video recordings of end-to-end micro-anastomoses were collected on days 1, 3, and 5, along with analysis of hand motion . Videos were assessed to calculate the QMUL Global Rating Scale (QMUL GRS). Two charts were created to track the acquisition of microsurgical skills. One to plot the number of hand movements and the other for QMUL GRS, against the participants' cumulative number of micro-anastomoses performed. Participant data were used to calculate a skills acquisition line for each quartile, analogous to percentiles on a growth chart. RESULTS For a cumulative number of 0 prior micro-anastomoses, the GRS score at the 25th, 50th, and 75th percentile was 45.5, 55, and 62, respectively. As the number of cumulative anastomoses increased, there was a distinct increase in the GRS score to 89.5, 93, and 92 for the group with 55-100 previous micro-anastomoses. This was in keeping with a decreased number of hand movements with increasing experience. CONCLUSION In conclusion, our tool allows trainees to track where they lie in the skill spectrum relative to prior experience which permits the provision of focused training to trainees at lower percentiles, which has potential to translate to improved clinical outcomes.
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Noël GPJC, Dubé J, Venne G. The Unintentional Effects on Body Donation Programs of a Competency-Based Curriculum in Postgraduate Medical Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:675-681. [PMID: 33152170 DOI: 10.1002/ase.2033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
As medical programs place increasing importance on competency-based training and surgical simulations for residents, anatomy laboratories, and body donation programs find themselves in a position of adapting to changing demands. To better assess the demand for "life-like" cadaveric specimens and evaluate the possible impacts that competency-based medical education could have upon the body donation program of McGill University, Canada, the authors tracked, over the course of the last 10 years, the number of soft-embalmed specimens, along with the number of teaching sessions and the residents enrolled in competency-based programs that are using cadaveric material. The results reveal that the number of soft-embalmed specimens used within residency training increased from 5 in 2009 to 35 in 2019, representing an increase from 6% of bodies to 36.5% of the total number of body donors embalmed in this institution. Correspondingly, the number of annual teaching sessions for residents increased from 19 in 2012 to 116 in 2019. These increases in teaching are correlated with increasing number of residents enrolled in competency-based programs over the last 3 years (Pearson r ranging from 0.9705 to 0.9903, and R2 ranging from 0.9418 to 0.9808). Those results suggest that the new skill-centered curricula which require residents to perform specific tasks within realistic settings, exhibit a growing demand for "life-like" cadaveric specimens. Institutions' body donation programs must, therefore, adapt to those greater need for cadaveric specimens, which presents many challenges, ranging from the logistical to the ethical.
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Affiliation(s)
- Geoffroy P J C Noël
- Division of Anatomical Sciences, Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Joseph Dubé
- Division of Anatomical Sciences, Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gabriel Venne
- Division of Anatomical Sciences, Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Al-Halabi B, Abi-Rafeh J, Jaberi M, Gilardino M. Preliminary Validation of a Stimulator for Markings in Surgery. Surg Innov 2021; 29:464-465. [PMID: 34461771 DOI: 10.1177/15533506211041910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Becher Al-Halabi
- Division of Plastic & Reconstructive Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Jad Abi-Rafeh
- Division of Plastic & Reconstructive Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Mehrad Jaberi
- Division of Plastic & Reconstructive Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Mirko Gilardino
- Division of Plastic & Reconstructive Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
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Abstract
Purpose: Surgical simulation of microvascular anastomosis has become increasingly popular. There are several living and silicone models available. Current silicone models fail to accurately reproduce a vessel’s loose adventitial layer, which may lead to the development of improper microsurgical technique. Our purpose is to create a realistic 3-dimensional microsurgical simulator that incorporates an adventitial vessel layer for higher fidelity manipulation of vessels. Methods: A microvascular anastomosis simulator was manufactured using metal moulds and inorganic materials. Synthetic tubing was created with a metal cylinder, 1.65 mm in diameter, painted with 2 sequential layers of silicon with a shore hardness of 2A. Silicone was allowed to fully cure in-between layers. Vessel adventitia was created with a 100-micron polyester mesh adhered to the silicone vessel exterior. Once dry, the synthetic tube is removed from the metal cylinder is then clipped to reveal the inner lumen. Both Resident and attending physicians evaluated the model with and without the adventitial layer and completed a questionnaire. Results: Grasping and manipulation of the vessel were scored on Average score 4.5 and 3 out of 5, with adventitia and without, respectively ( P = .00906). Usefulness as a teaching tool was scored on average 4.9 and 4.2, with adventitia and without, respectively ( P = .0232). The analysis included: simulation realism, educational utility, and overall satisfaction. Responses in all domains were favourable, suggesting the utility of this model. Conclusion: We created a realistic, high fidelity microvascular anastomosis simulator that is low cost and easily reproducible. Initial feedback is encouraging regarding realism, educational utility, and overall usefulness. Further validation is required to assess its effectiveness in resident education and skill transfer to the operating room.
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Gasteratos K, Paladino JR, Akelina Y, Mayer HF. Superiority of living animal models in microsurgical training: beyond technical expertise. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:167-176. [PMID: 33589852 PMCID: PMC7875764 DOI: 10.1007/s00238-021-01798-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
Background Many studies are investigating the role of living and nonliving models to train microsurgeons. There is controversy around which modalities account for the best microsurgical training. In this study, we aim to provide a systematic literature review of the practical modalities in microsurgery training and compare the living and nonliving models, emphasizing the superiority of the former. We introduce the concept of non-technical skill acquisition in microsurgical training with the use of living laboratory animals in the context of a novel proposed curriculum. Methods A literature search was conducted on PubMed/Medline and Scopus within the past 11 years based on a combination of the following keywords: “microsurgery,” “training,” “skills,” and “models.” The online screening process was performed by two independent reviewers with the Covidence tool. A total of 101 papers was identified as relevant to our study. The protocol was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Living models offer the chance to develop both technical and non-technical competencies (i.e., leadership, situation awareness, decision-making, communication, and teamwork). Prior experience with ex vivo tissues helps residents consolidate basic skills prior to performing more advanced techniques in the living tissues. Trainees reported a higher satisfaction rate with the living models. Conclusions The combination of living and nonliving training microsurgical models leads to superior results; however, the gold standard remains the living model. The validity of the hypothesis that living models enhance non-technical skills remains to be confirmed. Level of evidence: Not ratable.
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Affiliation(s)
- Konstantinos Gasteratos
- Department of Plastic and Reconstructive Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Yelena Akelina
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY USA
| | - Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
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Mattar TGDM, dos Santos GB, Telles JPM, de Rezende MR, Wei TH, Mattar R. Structured evaluation of a comprehensive microsurgical training program. Clinics (Sao Paulo) 2021; 76:e3194. [PMID: 34669876 PMCID: PMC8491592 DOI: 10.6061/clinics/2021/e3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study proposed a structured microsurgical training program and evaluated it with the assistance of a large sample of surgeons. METHODS The practical course comprised 16 sessions of approximately 4 hours each. This included two sessions for suturing rubber gloves and two sessions for suturing arteries, veins, and nerves in chicken thighs. The other sessions were performed on the femoral vessels of rats: 5 sessions for end-to-end arterial anastomosis, 5 for end-to-end venous anastomosis, 1 for arterial grafting, and 1 for end-to-side anastomosis. We conducted a structured assessment of the microsurgical skills in each training session. RESULTS In this study, 89 surgeons were evaluated. The mean scores for the different procedures were as follows: glove suturing, 33.3±0.59; chicken nerve end-to-end anastomosis, 40.3±0.49; chicken artery suturing, 40.9±0.36; chicken vein suturing, 42.3±0.36; graft interposition, 44.8±0.7; and end-to-side anastomosis, 43.7±0.63 (p<0.05 for all). The chicken thigh suturing scores were significantly higher than the rubber gloves suturing scores (p<0.01). There were no differences between scores of the rat artery and chicken thigh suturing procedures (p=0.24). The rat venous anastomosis scores were higher than the rat arterial anastomosis scores (p=0.02), as were graft interposition scores when compared with end-to-end venous anastomosis scores. The end-to-side anastomosis scores did not differ significantly from the grafting scores (p=0.85). The most common errors were inadequate knotting technique and suture rupture due to inadequate technique (both n=88 [98.9%]). CONCLUSION We propose a 16-step, progressive microsurgical training program to learn the basic microsurgical techniques comprehensively and reliably. The program was evaluated in a large sample of trainees, and it demonstrated the adequacy of the training sequence and results.
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Affiliation(s)
- Tiago Guedes da Motta Mattar
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Gustavo Bispo dos Santos
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | | | - Marcelo Rosa de Rezende
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Teng Hsiang Wei
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Rames Mattar
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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De Virgilio A, Costantino A, Ebm C, Conti V, Mondello T, Di Bari M, Cugini G, Mercante G, Spriano G. High definition three-dimensional exoscope (VITOM 3D) for microsurgery training: a preliminary experience. Eur Arch Otorhinolaryngol 2020; 277:2589-2595. [DOI: 10.1007/s00405-020-06014-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
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