Low-cost model using a digital microscope for learning, practicing, and maintaining microvascular surgical skills

Chai, Aaron; Crank, Stephen; Mizen, Kelvin; Philip, Jerome

doi:10.1016/j.bjoms.2020.08.077

Cited by 6 publications

(8 citation statements)

References 4 publications

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“…Our recommended setup consists of a digital microscope stabilized on a laboratory bench or tabletop that can video record sessions for feedback. We note that digital microscopes were particularly effective in our review at providing low-cost yet high image clarity magnification, 4,34 and we encourage trainees to use these microscopes to improve their microsurgical skills while saving costs. Many digital microscopes on the market arrive prestabilized with a builtin base and can easily record and save video input or wirelessly output video input to a smartphone, tablet, or laptop.…”

Section: Discussionmentioning

confidence: 94%

“…Two studies 4 34 described microsurgical training models using digital microscopes that resulted in significant improvements to user anastomosis skills graded by attendings using three standardized microsurgery evaluation scales (University of Western Ontario Microsurgery Skills Acquisition/Assessment, Objective Structured Assessment of Technical Skills—Task Specific Score, and Objective Structured Assessment of Technical Skills—Global Scale). 4 Setups were of low cost ($34–54), high magnification (×250), and portable; the digital microscope used by Chai et al 34 had a built-in screen to display the operative field, decreasing space required for setup. However, after user testing and feedback, key limitations of these training models included a shallow depth of focus and technological lag time.…”

Section: Resultsmentioning

confidence: 99%

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No Microscope? No Problem: A Systematic Review of Microscope-Free Microsurgery Training Models

Chen¹,

Xun²,

Abousy³

et al. 2021

J Reconstr Microsurg

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Background Benchtop microsurgical training models that use digital tools (smartphones, tablets, and virtual reality [VR]) for magnification are allowing trainees to practice without operating microscopes. This systematic review identifies existing microscope-free training models, compares models in their ability to enhance microsurgical skills, and presents a step-by-step protocol for surgeons seeking to assemble their own microsurgery training model. Methods We queried PubMed, Embase, and Web of Science databases through November 2020 for microsurgery training models and performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We collected data including training model characteristics (cost, magnification, and components) and outcomes (trainee satisfaction, image resolution, and faster suturing speed). We also conducted a complimentary Google search to identify commercially available microscope-free microsurgical training models or kits not reported in peer-reviewed literature. Results Literature search identified 1,805 publications; 24 of these met inclusion criteria. Magnification tools most commonly included smartphones (n = 10), VR simulators (n = 4), and tablets (n = 3), with magnification ranging up to ×250 magnification on digital microscopy, ×50 on smartphones, and ×5 on tablets. Average cost of training models ranged from $13 (magnification lens) to $15,000 (augmented reality model). Model were formally assessed using workshops with trainees or attendings (n = 10), surveys to end-users (n = 5), and single-user training (n = 4); users-reported satisfaction with training models and demonstrated faster suturing speed and increased suturing quality with model training. Five commercially available microsurgery training models were identified through Google search. Conclusion Benchtop microsurgery trainers using digital magnification successfully provide trainees with increased ease of microsurgery training. Low-cost yet high magnification setups using digital microscopes and smartphones are optimal for trainees to improve microsurgical skills. Our assembly protocol, “1, 2, 3, Microsurgery,” provides instructions for training model set up to fit the unique needs of any microsurgery trainee.

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Section: Discussionmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

No Microscope? No Problem: A Systematic Review of Microscope-Free Microsurgery Training Models

Chen¹,

Xun²,

Abousy³

et al. 2021

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…Since more affordable alternatives to high-quality microscopes and instruments such as magnifying loupes, smartphones, and tablets have become available, microsurgical training has become more accessible at home. 35 36 37 38 39 40 This seems to be especially interesting, as the study by Boecker et al suggests that implementation of regularly held in-house microsurgical training seems to reduce complication rate, operation time, and patient hospital stay. 41…”

Section: Discussionmentioning

confidence: 99%

Video-Based Microsurgical Education versus Stationary Basic Microsurgical Course: A Noninferiority Randomized Controlled Study

Dąbrowski

Stogowski

et al. 2022

J Reconstr Microsurg

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Background Repetitive training is essential for microsurgical performance. This study aimed to compare the improvement in basic microsurgical skills using two learning methods: stationary microsurgical course with tutor supervision and self-learning based on digital instructional materials. We hypothesized that video-based training provides noninferior improvement in basic microsurgical skills. Methods In this prospective study, 80 participants with no prior microsurgical experience were randomly divided into two groups: the control group, trained under the supervision of a microsurgical tutor, and the intervention group, where knowledge was based on commonly available online instructional videos without tutor supervision. Three blinded expert microsurgeons evaluated the improvement in basic microsurgical skills in both groups. The evaluation included an end-to-end anastomosis test using the Ten-Point Microsurgical Anastomosis Rating Scale (MARS10) and a six-stitch test on a latex glove. Statistically significant differences between groups were identified using standard noninferiority analysis, chi-square, and t-tests. Results Seventy-seven participants completed the course. Baseline test scores did not differ significantly between groups. After the 4-day microsurgical course, both groups showed statistically significant improvement in microsurgical skills measured using the MARS10. The performed tests showed that data for self-learning using digital resources provides noninferior data for course with surpervision on the initial stage of microsurgical training (7.84; standard deviation [SD], 1.92; 95% confidence interval [CI], 7.25–8.44) to (7.72; SD, 2.09; 95% CI, 7.07–8.36). Conclusion Video-based microsurgical training on its initial step provides noninferior improvement in microsurgical skills to training with a dedicated instructor.

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“…Overall, interval training groups showed statistically significant improvement in early development of microsurgical anastomotic skills, whereas the mass training group did not. 4 There is evidence that self-directed learning may benefit microsurgical skills and improve confidence and competence. 5,6 A commercially available product and smartphone camera provides an avenue for medical students and residents to consistently practice and develop their own interval training regimen.…”

Section: Discussionmentioning

confidence: 99%

“…This essentially means students are able to create their own microsurgical laboratory in their home for less than $500, compared with surgical training microscopes that average around $2500 and require access to a skills laboratory. 4 However, it is important to note that not all smartphones are the same and that image quality and magnification may vary between phone types.…”

Section: Ideas and Innovationsmentioning

confidence: 99%

Microsurgical Practice with Use of Smartphone Camera as the Microscopic Field

Johnson,

Johnson

2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Accessibility of microsurgical equipment is a major barrier to proper training of surgeons before live patient free flap surgery. A technique is presented that uses a smartphone camera as the microscopic field, eliminating the need for an expensive operative microscope for surgical practice. A convenient and cost-effective simulation protocol could reduce the time frame of the microsurgery learning curve. Furthermore, the use of the smartphone video function may allow improved feedback by mentors, improving access and communication between microsurgical teachers and learners. The PocketSuture smartphone stand is a commercially available device that allows the smartphone camera to be used as magnification. The proposed education protocol included suture practice, vessel dissection, and free tissue transfer in nonliving animal models, with vessel anastomosis and patency confirmation performed with a smartphone camera for field magnification. Video of the suturing technique allowed feedback from the mentor. A progressive suturing protocol leading to the ability to perform microsurgical anastomosis on nonliving animal models was developed. The basic costs for the stand, instrument set and suture were less than $500. The PocketSuture smartphone stand can be used for microsurgical training with real-time video for plastic surgery learners with limited access to microscopes and local mentors.

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Low-cost model using a digital microscope for learning, practicing, and maintaining microvascular surgical skills

Cited by 6 publications

References 4 publications

No Microscope? No Problem: A Systematic Review of Microscope-Free Microsurgery Training Models

No Microscope? No Problem: A Systematic Review of Microscope-Free Microsurgery Training Models

Video-Based Microsurgical Education versus Stationary Basic Microsurgical Course: A Noninferiority Randomized Controlled Study

Microsurgical Practice with Use of Smartphone Camera as the Microscopic Field

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