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

Abstract

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.

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

“…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…”

Fundamentals of Microsurgery: A Novel Simulation Curriculum Based on Validated Laparoscopic Education Approaches

“…These models can be isolated tasks or incorporated into training curricula using cadaveric models for anastomosis practice. 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Recent developments in microsurgical simulation and education even eliminate the use of a standard operating room microscope and instead incorporate a portable binocular microscope or monocular smartphone technology with video recording and feedback. 35 36 37 Some curricula rely on progression of skills based on learner postgraduate year (PGY), but reported outcomes are often not related to PGY level.…”

“…Recent developments in microsurgical simulation and education even eliminate the use of a standard operating room microscope and instead incorporate a portable binocular microscope or monocular smartphone technology with video recording and feedback. [35][36][37] Some curricula rely on progression of skills based on learner postgraduate year (PGY), but reported outcomes are often not related to PGY level. 12 The International Microsurgery Simulation Society consensus statement in 2020 emphasized the importance of nonbiologic models for instruction and need for objective assessment of trainees.…”

Evaluation of a Microsurgery Training Curriculum

“…There is some evidence to support that dry and wet laboratories have shown transferability to clinical practice, allowing progression through the learning curve without compromising patient safety [5]. Additionally, another systematic review showed that trainees could acquire skills without a microscope, using new smartphone technology with improved magnification and benchtop models [6].…”

“…5 Additionally, another systematic review showed that trainees could acquire skills without a microscope, using new smartphone technology with improved magnification and benchtop models. 6…”