TY - JOUR
T1 - Factors Correlating With Microsurgical Performance
T2 - A Clinical and Experimental Study
AU - Schaverien, Mark V.
AU - Liu, Jun
AU - Butler, Charles E.
AU - Selber, Jesse C.
N1 - Funding Information:
This research was supported in part by an intramural Grant from the Kyte Foundation (MD Anderson Department of Plastic Surgery) and the NIH/NCI, United States under Award no. P30CA016672.
Publisher Copyright:
© 2018
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background: Microsurgery is one the most complex surgical skills to master. The factors correlating with microsurgical performance, however, are poorly understood. Understanding these factors will aid in the training and assessment of microsurgeons. Methods: A total of 29 microsurgery fellows enrolled in a dedicated 1-year microsurgery fellowship were included in the study. For the clinical evaluations, microsurgical anastomosis performance was evaluated during multiple procedures in the operating room at the start, midpoint, and end of the fellowship by all departmental faculty using a validated microsurgical assessment tool. For the laboratory evaluations, blinded video recordings of each fellow performing an arterial femoral anastomosis in a live rat model at the start and end of the fellowship were evaluated using 3 validated microsurgical global ratings scale tools. Correlations between performance and the factors assessed by the tools were evaluated. Results: In the clinical study there were a total of 474 anastomosis evaluations; clinical performance correlated best with speed, instrument handling, and motion. In the laboratory study 58 evaluations were conducted, and performance tracked most closely with instrument handling, flow of operation, and operative steps, as well as correlating significantly inversely with time taken. The most common errors committed were unequal stitch bites, wrong grasp/damage tissue, and loose knot. Conclusions: Speed, both subjective and objective, instrument handling, operative flow, and motion, were relevant to performance of a microsurgical anastomosis. A prospective trial is now necessary to determine whether these factors should be considered in definitions of competency in microsurgery training pathways.
AB - Background: Microsurgery is one the most complex surgical skills to master. The factors correlating with microsurgical performance, however, are poorly understood. Understanding these factors will aid in the training and assessment of microsurgeons. Methods: A total of 29 microsurgery fellows enrolled in a dedicated 1-year microsurgery fellowship were included in the study. For the clinical evaluations, microsurgical anastomosis performance was evaluated during multiple procedures in the operating room at the start, midpoint, and end of the fellowship by all departmental faculty using a validated microsurgical assessment tool. For the laboratory evaluations, blinded video recordings of each fellow performing an arterial femoral anastomosis in a live rat model at the start and end of the fellowship were evaluated using 3 validated microsurgical global ratings scale tools. Correlations between performance and the factors assessed by the tools were evaluated. Results: In the clinical study there were a total of 474 anastomosis evaluations; clinical performance correlated best with speed, instrument handling, and motion. In the laboratory study 58 evaluations were conducted, and performance tracked most closely with instrument handling, flow of operation, and operative steps, as well as correlating significantly inversely with time taken. The most common errors committed were unequal stitch bites, wrong grasp/damage tissue, and loose knot. Conclusions: Speed, both subjective and objective, instrument handling, operative flow, and motion, were relevant to performance of a microsurgical anastomosis. A prospective trial is now necessary to determine whether these factors should be considered in definitions of competency in microsurgery training pathways.
KW - Practice-Based Learning and Improvement
KW - clinical
KW - evaluation
KW - experimental
KW - fellow
KW - microsurgery
KW - performance
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U2 - 10.1016/j.jsurg.2017.11.003
DO - 10.1016/j.jsurg.2017.11.003
M3 - Article
C2 - 29199083
AN - SCOPUS:85035774289
VL - 75
SP - 1045
EP - 1051
JO - Journal of Surgical Education
JF - Journal of Surgical Education
SN - 1931-7204
IS - 4
ER -