Simple training tricks for mastering and taming bypass procedures in neurosurgery

Abstract

Background:Neurosurgeons devoted to bypass neurosurgery or revascularization neurosurgery are becoming scarcer. From a practical point of view, “bypass neurosurgeons” are anastomosis makers, vessels technicians, and time-racing repairers of vessel walls. This requires understanding the key features and hidden tricks of bypass surgery. The goal of this paper is to provide simple and inexpensive tricks for taming the art of bypass neurosurgery. Most of these tricks and materials described can be borrowed, donated, or purchased inexpensively.Methods:We performed a review of relevant training materials and recorded videos for training bypass procedures for 3 years between June 2014 and July 2017. In total, 1,300 training bypass procedures were performed, of which 200 procedures were chosen for this paper.Results:A training laboratory bypass procedures is required to enable a neurosurgeon to develop the necessary skills. The important skills for training bypass procedures gained through meticulous practice to be as reflexes are coordination, speed, agility, flexibility, and reaction time. Bypassing requires synchronization between the surgeon's gross movements, fine motoric skills, and mental strength. The suturing rhythm must be timed in a brain–body–hand fashion.Conclusion:Bypass-training is a critical part of neurosurgical training and not for a selected few. Diligent and meticulous training can enable every neurosurgeon to tame the art of bypass neurosurgery. This requires understanding the key features and hidden tricks of bypass surgery, as well as uncountable hours of training. In bypass neurosurgery, quality and time goes hand in hand.

The Identification of Factors That Influence the Quality of Bypass Anastomosis and an Evaluation of the Usefulness of an Experimental Practical Scale in This Regard

“…21,22 Actions that do not fulfil their objective and time taken to perform the bypass Actions that do not achieve their objective consume time and, more importantly, disturb eye-hand orientation, the flexibility of the surgeon and self-confidence. 2,3,13,23,24 Although time is always measured during a bypass procedure, it is difficult to quantify the most optimal cut-off. The criterion of speed is not as important as the achievement of speed in combination with the other evaluated factors, i.e., achieving a score of 1 for completing the procedure in ≤ 20 minutes is more…”

“…Vital steps need to be taken to ensure the quality of vascular anastomosis during bypass surgery. [1][2][3][4][5][6][7][8][9][10][11] It is critical to ensure that the time taken to minimise blood flow during the procedure is as brief as possible as this is a significant source of stress for the neurosurgeon 12,13 and can impact on the quality of suturing.…”

Meditation music improved the quality of suturing in an experimental bypass procedure

“…The trainees experience a different levels of stress and anxiety before and during surgical procedures [3,12,22]. Neurosurgical operations hold high level of anxiety, demands certain level of hand-eye coordination, and fine manipulation [4,6,8,17,36].…”

Developing microsurgical milestones for psychomotor skills in neurological surgery residents as an adjunct to operative training: the home microsurgery laboratory

“…A similar notion of home-based learning has been alluded to in the neurosurgical literature, 22 though the described method was limited to training entirely via suturing strands of gauze, without expansion into more translatable models. Hafez et al 23 reviewed important technical pearls for performing cerebral bypass and also suggested a rigorous training curriculum: at least 1 hour per day using 7-0 and 8-0 sutures (3 months); another minimum 1 hour per day using 9-0 suture (3 months); a minimum 1 hour per day with 10-0 suture, focusing on speed (270 hours to achieve "expertise"); and finally, at least 1 hour biweekly to maintain expertise. We propose an expansion specific to neurosurgical training, with detailed training regimens and guidelines for both home and clinical training, that extends beyond bypass/microsuture training.…”