Evaluation of the efficacy of microsurgical practice through time factor added protocol: microsurgical training using nonvital material.
OBJECTIVE
The evaluation of microsurgical technique is often done in an attempt to enhance the skills of surgeons. However, it varies depending on the institution or supervisors. According to some of the research done so far, there are many institutes that enable surgeons to train themselves with enough time but are confronted with some other limiting factors. We have added the time factor and conducted our study on the evaluation of microsurgical techniques. The purpose of this study was to decide whether using a nonvital pig leg saves microsurgical training time and improves microsurgical skill and how effective this method is in an objective assessment.


METHODS
For 3 pig legs, the full procedure time was calculated 3 times and the anastomosis duration was measured 5 times for a total of 8 trainees. The authors made evaluations conforming to the following protocol. The full procedure time was defined as the time period between when students entered and left the laboratory, including the time for preparation and cleaning up. The anastomosis time included just one anastomosis at the time of vessel cutting. An objective evaluation of vessel anastomosis was performed using a 5-point global rating scale in 6 categories. For suture errors, we calculated the number of broken sutures, broken knots, and broken or damaged needles. After anastomosis, leakage was tested using an infusion pump. For an objective analysis, the study was limited to arterial end-to-end anastomosis and all the parameters were measured by a single trainer.


RESULTS
For the full procedure time, 129.0 (13.8) minutes was needed for the first trial, whereas the third trial took 72.4 (11.1) minutes (P < 0.05). For the anastomosis time, the first trial took 47.1 (14.7) minutes, whereas the fifth took 18.0 (2.1) minutes. There was a statistical significance, except between the third and fourth trials. Improvement in the global rating scale was noted with increased procedure frequency. The mean total score (30 points is perfect) was 8.9 (1.5) at the first trial, which improved to 25.0 (0.9). As for the suture errors, 7.5 (1.3) errors were noted on the first trial, which was reduced to 1.6 (0.7) on the fifth trial.


CONCLUSIONS
The authors carried out microsurgical training using a protocol that added the time factor to the conventional evaluation studies. Microsurgical practice with pig legs statistically saves time and improves the skill in 3 full procedures including 5 practice end-to-end arterial anastomoses. This is an effective and economic method of developing the basic techniques performed during anastomosis procedures.
Hong
Jong Won
JW
Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Kim
Young Seok
YS
Lee
Won Jai
WJ
Hong
Hyun Joon
HJ
Roh
Tai Suk
TS
Song
Seung Yong
SY
D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000592:standards; D000818:Animals; D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D007866:Leg / Q000098:blood supply; D008866:Microsurgery / Q000193:education* / Q000592:standards*; D013552:Swine; D013997:Time Factors