Learning curve and influencing factors of performing microsurgical anastomosis: a laboratory prospective study

Lefevre, Etienne; Ganau, Mario; Zaed, Ismail; Machado-Filho, Guaracy de Macedo; Scibilia, Antonino; Mallereau, Charles-Henry; Bresson, D.; Todeschi, Julien; Cébula, H.; Proust, F.; Vignes, J.-L.; Masquelet, Alain-Charles; Facca, S.; Livernaux, Philippe; Alfieri, Alex; Ramos, Taise Cruz Mosso; Magaldi, Marcelo; Bruno, Carmen; Chibbaro, Salvatore

doi:10.1007/s10143-022-01856-7

Cited by 9 publications

(5 citation statements)

References 26 publications

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“…The participants were not allowed to perform any microsurgical training during the assessments. It has been reported that microsurgical training significantly improved after 4 months or more of continuous training, 19 and there will be little significant learning effect from a single session. Third, night shift work and caffeine intake were not taken into account.…”

Section: Discussionmentioning

confidence: 97%

Effect of Sleep Deprivation on Simulated Microsurgical Vascular Anastomosis

Ito

Hafez

Hosoo

et al. 2023

J Neurol Surg A Cent Eur Neurosurg

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Background: The effects of sleep deprivation on surgical performance have been well documented. However, reports on the effects of sleep deprivation on microneurosurgery are limited. This study aimed to investigate the effects of sleep deprivation on microneurosurgery. Methods: Ten neurosurgeons participated in the anastomosis of a vessel model using a microscope in sleep-deprived and normal states. We evaluated the procedure time (PT), stitch time (ST), interval time (IT), number of unachieved movements (NUM), leak rate, and practical scale for anastomosis quality assessment. Each parameter was compared between normal and sleep-deprived states. Sub-analyses were performed on the two groups based on PT and NUM under the normal state (proficient and non-proficient groups). Results: Although no significant differences were noted in PT, ST, NUM, leak rate, or practical scale, IT was significantly prolonged under sleep deprivation compared to the normal state (mean, 258.8 ± 94.0 vs. 199.3 ± 74.9 s, p = 0.02). IT was significantly prolonged under sleep deprivation in the non-proficient group based on both PT and NUM (PT, 234.2 ± 71.6 vs. 321.2 ± 44.7 s, p = 0.04, NUM, 173.3 ± 73.6 vs. 218.7 ± 97.7; p = 0.02), whereas no significant difference was observed in the proficient group (PT, 147.0 ± 47.0 vs. 165.3 ± 61.1 s, p = 0.25, NUM, 173.3 ± 73.6 vs. 218.7 ± 97.7; p = 0.25). Conclusions: Although IT was significantly prolonged under sleep deprivation in the non-proficient group, there was no decline in performance skills in either the proficient or non-proficient group. The effect of sleep deprivation may require caution in the non-proficient group, but it is possible that certain microneurosurgical outcomes can be achieved under sleep deprivation.

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Section: Discussionmentioning

confidence: 97%

Effect of Sleep Deprivation on Simulated Microsurgical Vascular Anastomosis

Ito

Hafez

Hosoo

et al. 2023

J Neurol Surg A Cent Eur Neurosurg

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“…All anastomoses were performed by A.H., who has performed over 3000 experimental bypasses including around 400 using an exoscope. We opted for an experienced surgeon to limit the effect of factors that are related to the learning curve and specifically address the objective how an experiences neurovascular surgeon adapts to working with different exoscopes [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

3D Exoscopes in Experimental Microanastomosis: A Comparison of Different Systems

Hafez

Haeren

Huhtakangas

et al. 2023

Life

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Background: In recent years, three-dimensional exoscopes have been increasingly applied in neurosurgery. Multiple exoscopic systems are available, all offering specific features. In this study, we assessed practical and visualization performance of four different exoscopic systems in a highly challenging microsurgical procedure, and evaluated whether these affected the quality of work. Methods: We included four different exoscopes: Olympus ORBEYE, Zeiss KINEVO, Storz VITOM, and Aesculap AEOS. With each exoscope, ten experimental bypass procedures were carried out on chicken wing vessels at a depth of 3 cm. We evaluated the quality of the anastomoses, the practical considerations for the setup of the exoscopic systems, and the visualization quality by tracking the number of unnecessary movements. Results: All included exoscopes enabled us to perform the bypass procedures with mostly adequate or excellent results. Surgically, the most pronounced difference between the exoscopes was the duration of the procedure, which was mainly due to the number of unnecessary movements. Practically, the exoscopes differ highly which is important when considering which exoscope to apply. Conclusions: This is the first study comparing different exoscope systems while performing the same challenging microsurgical procedure. We found major practical differences between the exoscopes that determine the suitability of an exoscope based on the demands and conditions of the surgical procedure. Therefore, preprocedural practical training with the exoscope is required.

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“…This will benefit the Dupuytren’s patient in general elective surgery, but also in acute settings, since secondary referral for urgent revascularization to a replantation center has been reported ( 20 ). Most likely, since practical training and exposure is the most important factor to improve performance, the skills of the surgeon will increase as a consequence of increased exposure to microsurgery, which probably benefits education and other hand surgical cases such as trauma and revascularization ( 35 ). Even more, as proficiency-based progression research and training has clearly demonstrated, it is the skill of the surgeon that has the highest impact on improving surgical outcome ( 36 ).…”

Section: Rationale For Microsurgery In Dupuytren’s Fasciectomymentioning

confidence: 99%

Microfasciectomy in Dupuytren’s disease: microsurgery in the evolution toward safer and more efficient fasciectomy and hand surgery

2023

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In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren’s contracture. The risk for complications is significant, certainly in recurrent disease and in the presence of abundant scar tissue. Meticulous surgical technique is mandatory. Microsurgery increases magnification from four times (with surgical loupes) up to 40 times. Using the microscope in Dupuytren’s surgery, a technique named microfasciectomy is likely to increase both safety and efficiency by preventing instead of treating surgical complications. Increased experience with microsurgery will benefit Dupuytren’s treatment and hand surgery in general.

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Learning curve and influencing factors of performing microsurgical anastomosis: a laboratory prospective study

Cited by 9 publications

References 26 publications

Effect of Sleep Deprivation on Simulated Microsurgical Vascular Anastomosis

Effect of Sleep Deprivation on Simulated Microsurgical Vascular Anastomosis

3D Exoscopes in Experimental Microanastomosis: A Comparison of Different Systems

Microfasciectomy in Dupuytren’s disease: microsurgery in the evolution toward safer and more efficient fasciectomy and hand surgery

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