Microsurgical Skills Trainer with Quantitative Feedback
Evan S. Garfein, MD, Brad Kligman, BS, Nicholas Haddock, MD, Jamie P. Levine, MD.
New York University School of Medicine, New York, NY, USA.
Introduction: General surgical skills of suturing and handling tissues are acquired by multiple repetitions. While various artificial training tools have been described, most surgeons learn to operate on patients by operating on patients. Most skills, like the pronation and supination of suturing, are generalizable and can be applied across multiple surgical fields. Microsurgical skills, especially the anastomosing of small vessels, are used less frequently and are less fungible. By definition, performing these skills requires a microscope, specialized instruments and suture, and an appropriate structure on which to operate. Repetition is no less an important part of training, however. In this paper, we describe a simple, inexpensive microsurgical training tool that allows students and residents to simulate performing microvascular anastomoses with built-in quantitative analysis of performance.
Materials and Methods: The training tool includes a small lucite platform, a double-opposing clamp, and thin-walled silicone tubing with an outer diameter of 0.94mm and an inner diameter of 0.64mm. The tubing is attached on one end to a fluid-filled syringe and, on the other, to a pressure gauge.
Results: Using the Microsurgical trainer and 9-0 Nylon suture, it is possible for a single operator to perform an anastomosis in an interrupted fashion. After completion of the anastomosis, fluid is pumped through the tubing and leak-pressure is measured. Time-to-complete and leak-pressure are measured and recorded for future comparison.
Summary: Microsurgical skills can be difficult and expensive to practice. Often, they are learned on experimental animals or during actual operative procedures. In this report, we describe a simple, inexpensive device that facilitates not only the practicing of microsurgical skills but provides quantitative feedback to the operator on the success of the exercise.