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

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.

Microsurgical Anastomosis Rating Scale (MARS10): A Final Product Scoring System for Initial Microsurgical Training.

BACKGROUND: High cost and ethical controversy of using living models in microsurgical training made non-living models more popular. However, non-living models don't provide appropriate feedback of microsurgical performance. Currently existing Global Rating Scales used for advanced microsurgical skills validation are difficult to apply on non-living model. This study presents a simple instrument for basic assessment of microsurgical anastomosis on non-living model. METHODS: Seventy medical students were divided into 2 groups depending on their prior microsurgical experience. Each participant performed 3 end-to-end anastomoses on chicken femoral artery model. Anastomoses were reviewed by 3 blinded experts and then photographed. Evaluation included a patency tests, longitudinal cut of anastomosis, and the newly proposed tool 10 Point Microsurgical Anastomosis Rating Scale (MARS10). Presented scale consists of 5 factors important for anastomosis closure (anastomosis closure, suture spacing, bites size, knot tying, and cut ends length), graded on 3 point scale (0-2 points). Results were analyzed with analysis of variance, Spearman correlation, and t Student test. RESULTS: Anastomoses evaluated by experts as patent significantly correlated with a high summary score in MARS10 scale (r = 0.73 P < .0001). There was a significant difference in MARS10 score between groups (P < .0001). There were no significant inter-rater differences in scoring among all 3 evaluators (p > .05). CONCLUSIONS: 10 Point Microsurgical Anastomosis Rating Scale is a quick, valid, and reliable tool to assess microsurgical end-to-end arterial anastomoses on non-living model.

HISTORIQUE: Le coût élevé et la controverse éthique liés à l'utilisation de modèles vivants pendant la formation en microchirurgie ont popularisé l'utilisation des modèles non vivants. Cependant, les modèles non vivants ne donnent pas de commentaires appropriés sur l'exécution de la microchirurgie. Les échelles d'évaluation mondiales actuellement utilisées pour valider les habiletés microchirurgicales avancées sont difficiles à appliquer sur des modèles non vivants. La présente étude propose un simple instrument d'évaluation fondamentale de l'anastomose microchirurgicale sur un modèle non vivant. MÉTHODOLOGIE: Les chercheurs ont divisé 70 étudiants en médecine en deux groupes d'après leur expérience microchirurgicale. Chaque participant a effectué trois anastomoses bout à bout sur un modèle d'artère fémorale de poulet. Trois experts ont examiné les anastomoses en aveugle puis les ont photographiées. L'évaluation incluait un test de perméabilité, la coupe longitudinale de l'anastomose et la nouvelle échelle d'évaluation de l'anastomose microchirurgicale en 10 points (MARS10). Cette échelle est composée de cinq facteurs importants pour fermer l'anastomose (fermeture de l'anastomose, espace entre les sutures, dimension des piqûres d'aiguille, exécution des nœuds et longueur des extrémités de fils), classés sur une échelle de trois points (de 0 à 2). Les chercheurs ont analysé les résultats avec l'analyse de variance, la corrélation de Spearman et le test de Student. RÉSULTATS: Les anastomoses évaluées comme perméables par les experts étaient corrélées par un sommaire de cotation élevé dans l'échelle de MARS10 (r = 0,73 P < 0,0001). Il y avait une différence significative du score MARS10 entre les groupes (p < 0,0001). Il n'y avait pas de différences interévaluateur significatives dans les scores des trois évaluateurs (p > 0,05). CONCLUSIONS: L'échelle de MARS10 est un outil rapide, valide et fiable pour évaluer les anastomoses artérielles microchirurgicales bout à bout sur des modèles non vivants.