title: Anastomosis Lapse Index (ALI): A Validated End Product Assessment Tool for Simulation Microsurgery Training.
abstract: BACKGROUND
  Over the last decade, simulation has become a principal training method in microsurgery. With an increasing move toward the use of nonliving models, there is a need to develop methods for assessment of microvascular anastomosis skill acquisition substituting traditional patency rate. The authors present and validate a novel method of microvascular anastomosis assessment tool for formative and summative skills competency assessment.
  
  
  METHODS
  In this study, 29 trainees with varying levels of experience in microsurgery undertook a 5-day microsurgery course. Two consecutive end-to-end microvascular anastomoses of cryopreserved rat aortas performed on day 3 and day 5 of the course were longitudinally split and photographed for randomized blinded qualitative evaluation. Four consecutive anastomoses by two experienced microsurgeons were analyzed as expert controls. Errors potentially leading to anastomotic leak or thrombosis were identified and logged. Statistical analysis using the Kruskal-Wallis analysis of variance (ANOVA) and a two-way repeated measure ANOVA was used to measure construct and concurrent validity, respectively.
  
  
  RESULTS
  A total of 128 microvascular anastomoses were analyzed for both student and control groups. Ten errors were identified and indexed. There was a statistically significant difference detected between average errors per anastomosis performed between groups (p < 0.05). Average errors per anastomosis was statistically decreased on day 5 of the course compared with day 3 (p < 0.001).
  
  
  CONCLUSIONS
  Evaluation of anastomosis structural patency and quality in nonliving models is possible. The proposed error list showed construct and predictive validity. The anastomosis lapse index can serve as a formative and summative assessment tool during microvascular training.
authors.affiliation: Academic Plastic Surgery Group, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Ghanem
authors.affiliation: Academic Plastic Surgery Group, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Al Omran
authors.affiliation: Academic Plastic Surgery Group, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Bashar
authors.initials: B
authors.lastname: Shatta
authors.affiliation: Academic Plastic Surgery Group, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Eunsol
authors.initials: E
authors.lastname: Kim
authors.affiliation: Academic Plastic Surgery Group, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Myers
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education*; D057868:Anastomotic Leak / Q000175:diagnosis; D000818:Animals; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004504:Education, Medical, Undergraduate; D008866:Microsurgery / Q000193:education*; D051381:Rats; D000066908:Simulation Training / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis