ABSTRACT
PIP: A plan for training gynecologists in microsurgical techniques is described. Candidates for microsurgical training should be obstetrician-gynecologists with a broad background in the field of marital infertility and knowledge of the biology of reproduction and especially of tubal physiopathology. Candidates should also have had a theoretical and practical course in gynecological microsurgery including 2 days of basic practice on experimental animals to become familiar with the basic microsurgical principles. The training program includes a phase of experimental microsurgery undertaken in a microsurgery laboratory and a 2nd phase of observation and participation in reconstructive surgery on infertile women in the operating room. A multidisciplinary microsurgical laboratory helps control costs and encourages communication and sharing of ideas between different specialists. The requirements for such a laboratory are relatively simple; a list of basic materials is suggested. The rat appears to be an adequate animal model for training purposes. The 1st days of training should be continuous and the student should avoid other commitments. Training periods should be 4-8 hours daily but 10 minutes of rest are needed each hour or when the student is fatigued or begins to repeat errors. Lack of sleep and exercise within the 24 hours preceding practice are associated with residual trembling of the hands and should be avoided, but use of alcohol and smoking are less definite problems. The student must also be prepared to overcome considerable initial frustration. Basic procedures should be mastered at the beginning of training, including the correct posture of the operator, placement of the arms and hands, adjustment of the microscope, placement of the microsurgical instruments, and method of picking up the instruments. The 1st 8-12 hours of practice should be done in surgical gloves to learn the handling of microsurgical instruments under the visual field of the microscope at different magnifications, placement of sutures, and practice with simple and double knots. The recommended next steps are anastomosis of the uterine cornu of the rat, anastomosis of surgically removed human fallopian tubes, and microvascular anastomosis of femoral vessels in the rat, including end-to-end arterial and venous anastomosis, end-to-end arterial-venous anastomosis, and venous grafts after arterial segmental excision. A minimum of 60 hours is recommended for this stage of training, but the practice required will vary according to individual abilities. Assistance to an experienced gynecological microsurgeon during 12-15 different reconstructive procedures is recommended for the next phase of training.^ieng