Does the repetition over a short time of a microsurgical suture improve its reliability?

Use of Stroboscopic Goggles in Suture Training Improves Precision and Accuracy

BACKGROUND

This study aimed to quantify the impact of intermittent visual occlusion via stroboscopic goggles on suture accuracy and precision.

METHODS

This crossover study recruited and randomized 72 graduate students to train with stroboscopic goggles early or late in structured suture practice. Participants completed assessments of 10 running sutures with 2 training sessions between baseline and follow-up assessments. The procedure was repeated after crossover. Suture photos were analyzed using ImageJ. Total error among all measurements represented accuracy; standard deviation of error represented precision. Intra- and inter-group trends were identified with Wilcoxon rank-sum tests.

RESULTS

Both groups significantly improved in accuracy in the sessions immediately following goggle use, but the group that used goggles later in training continued improving in accuracy and precision while the group that trained with stroboscopic goggles early plateaued.

CONCLUSIONS

Using stroboscopic goggles showed quantifiable benefit for augmenting suture training with greatest effect after initial skill acquisition is completed.

Smoothing the steep microsurgery learning curve: considering alternative suture sizes for early-stage microsurgery training with in vivo rat models

Background

Laboratory microsurgery training using invivo rat models is essential for clinical operation. However, challenges existin a structured training course when students transition from a non-livingmodel exercise to a living one. In the present article, we first demonstratethis steep learning curve in early-stage microsurgery training. We then proposethe potential solution of using various sizes of sutures for different trainingpurposes.

Methods

Twoseparate preliminary studies were included. First, we reviewed the records of25 students enrolled in our basic microsurgery training course. Each studentcompleted exercises in a non-living model before graduating to a live animalmodel where their performance on end-to-end arterial and venous anastomoses wasevaluated. Second, we examined the feasibility of different suture sizes in amillimeter microvascular anastomosis. Four groups of identical procedures inrat femoral artery were completed using sutures from 8-0 to 11-0. Patency rateand mean blood flow at 60 min post-op were measured and compared.

Results

Thirty-minute patency rates for firstarterial and venous anastomoses were 18/25 and 14/25. Those students who hadnon-patent anastomoses spent significantly longer time than those who hadpatent ones (p<.05). For varioussuture sizes, all groups achieved a 100% patency rate. No significantdifferences were found between the mean blood flow volume at 60 min post-op (p>.05).

Conclusions

Steep learning curve existed in the early-stagemicrosurgery training when transitioning from non-living to living exercisemodels. The feasibility of using various suture sizes in millimeter anastomosismay be a potential solution for instructors to ease this steep learning curve.Level of Evidence: Not gradable.

The Benefits of Expert Instruction in Microsurgery Courses

BACKGROUND

 Microsurgery requires repeated practice and training to achieve proficiency, and there are a variety of curriculums available. This study aims to determine the importance of an expert instructor to guide students through procedures. We compared student proficiency across two microsurgery courses: one with (Columbia University, United States [CU] cohort) and one without a dedicated microsurgery instructor (University of Thessaloniki, Greece [UT] cohort).

METHODS

 Students were divided into two cohorts of 22 students (UT cohort) and 25 students (CU cohort). Student progress was evaluated by examining patency (lift-up and milking tests), anastomotic timing, and quality (Anastomosis Lapse Index [ALI]) of end-to-end arterial and venous anastomoses on day 1 and again on day 5. Chi-squared tests evaluated patency immediately and 30 minutes postoperation. t-Tests evaluated anastomotic timing and ALI scores. p-Values < 0.05 were considered significant.

RESULTS

 We evaluated progress within and between each cohort. Within the CU cohort, the quality of the arterial and venous anastomosis improved, respectively (by 54%, p = 0.0059 and by 43%, p = 0.0027), the patency of both the arterial and venous anastomosis improved, respectively (by 44%, p = 0.0002 and by 40%, p = 0.0019), and timing of arterial and venous anastomosis reduced respectively (by 36%, p = 0.0002 and by 33%, p = 0.0010). The UT cohort improved the quality of their arterial anastomoses (by 29%, p = 0.0312). The UT cohort did not demonstrate significant improvement in the other above-mentioned parameters. The CU cohort improved materially over the UT cohort across categories of quality, patency, and timing.

CONCLUSION

 There are clear benefits of an expert instructor when examining the rate of progress and proficiency level attained at the conclusion of the course. We suggest students who are seeking to maximize proficiency in microsurgical procedures enroll in courses with an expert instructor.