title: Effectiveness of suturing training with 10-0 nylon under fixed and maximum magnification (x 20) using desk type microscope.
abstract: BACKGROUND
  Microvascular anastomosis using 10-0 nylon needs a higher level of technical dexterity compared with routine neurosurgical maneuvers. Although this technique remains an important part of treating complex intracranial aneurysms or cerebrovascular disease, the surgeon's clinical experience in using this technique is not so common.
  
  
  METHODS
  To improve dexterity and maneuverability in the limited clinical case volume, we developed an easily accessible training system, using commercially available desk type microscope and simply suturing neighboring fibers of the gauze with 10-0 nylon under fixed and highest (x 20) magnification.
  
  
  RESULTS
  This training system is somewhat of a drawback compared to the simulation of a real clinical setting. However, because of the extremely easy availability and accessibility of the dark type microscope repeated training and the accumulation of more than 10000 stitches, on average, was accomplished. This resulted in a steep learning curve of the technique.
  
  
  CONCLUSIONS
  For residency and post-residency year young neurosurgeons, who need to brush up their skills due to lower surgical case volume compared with what senior neurosurgeons have experienced this easily available training would contribute to establishing daily and long-lasting microsurgical practice.
authors.affiliation: Department of Neurosurgery, Showa General Hospital, Tokyo 187-8510, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Inoue
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Shinobu
authors.initials: S
authors.lastname: Adachi
authors.forename: Shota
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Saito
authors.forename: Naoto
authors.initials: N
authors.lastname: Kunii
mesh_terms: D006801:Humans; D008853:Microscopy / Q000295:instrumentation*; D008866:Microsurgery / Q000193:education*; D019635:Neurosurgical Procedures / Q000193:education*; D009757:Nylons; D013536:Suture Techniques / Q000193:education*; D013537:Sutures; D013663:Teaching
chemical_list: D009757:Nylons