Hong Jong Won, Kim Young Seok, Lee Won Jai, Hong Hyun Joon, Roh Tai Suk, Song Seung Yong
Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea.
J Craniofac Surg. 2010 May;21(3):876-81. doi: 10.1097/SCS.0b013e3181d7f2c7.
The evaluation of microsurgical technique is often done in an attempt to enhance the skills of surgeons. However, it varies depending on the institution or supervisors. According to some of the research done so far, there are many institutes that enable surgeons to train themselves with enough time but are confronted with some other limiting factors. We have added the time factor and conducted our study on the evaluation of microsurgical techniques. The purpose of this study was to decide whether using a nonvital pig leg saves microsurgical training time and improves microsurgical skill and how effective this method is in an objective assessment.
For 3 pig legs, the full procedure time was calculated 3 times and the anastomosis duration was measured 5 times for a total of 8 trainees. The authors made evaluations conforming to the following protocol. The full procedure time was defined as the time period between when students entered and left the laboratory, including the time for preparation and cleaning up. The anastomosis time included just one anastomosis at the time of vessel cutting. An objective evaluation of vessel anastomosis was performed using a 5-point global rating scale in 6 categories. For suture errors, we calculated the number of broken sutures, broken knots, and broken or damaged needles. After anastomosis, leakage was tested using an infusion pump. For an objective analysis, the study was limited to arterial end-to-end anastomosis and all the parameters were measured by a single trainer.
For the full procedure time, 129.0 (13.8) minutes was needed for the first trial, whereas the third trial took 72.4 (11.1) minutes (P < 0.05). For the anastomosis time, the first trial took 47.1 (14.7) minutes, whereas the fifth took 18.0 (2.1) minutes. There was a statistical significance, except between the third and fourth trials. Improvement in the global rating scale was noted with increased procedure frequency. The mean total score (30 points is perfect) was 8.9 (1.5) at the first trial, which improved to 25.0 (0.9). As for the suture errors, 7.5 (1.3) errors were noted on the first trial, which was reduced to 1.6 (0.7) on the fifth trial.
The authors carried out microsurgical training using a protocol that added the time factor to the conventional evaluation studies. Microsurgical practice with pig legs statistically saves time and improves the skill in 3 full procedures including 5 practice end-to-end arterial anastomoses. This is an effective and economic method of developing the basic techniques performed during anastomosis procedures.
对显微外科技术的评估通常是为了提高外科医生的技能。然而，评估方式因机构或导师而异。根据目前已开展的一些研究，有许多机构能让外科医生有足够时间进行自我训练，但也面临一些其他限制因素。我们加入了时间因素，对显微外科技术评估进行了研究。本研究的目的是确定使用非活体猪腿是否能节省显微外科训练时间、提高显微外科技能，以及该方法在客观评估中效果如何。
对3条猪腿，8名学员每人计算3次完整操作时间并测量5次吻合时间。作者按照以下方案进行评估。完整操作时间定义为学生进入实验室至离开实验室的时间段，包括准备和清理时间。吻合时间仅指血管切断时的一次吻合。使用5分制整体评分量表对血管吻合进行6个类别的客观评估。对于缝合错误，我们计算断针、断结以及断针或损坏针的数量。吻合后，使用输液泵测试渗漏情况。为进行客观分析，研究限于动脉端端吻合，所有参数均由一名培训师测量。
完整操作时间方面，第一次试验需要129.0（13.8）分钟，而第三次试验需要72.4（11.1）分钟（P<0.05）。吻合时间方面，第一次试验需要47.1（14.7）分钟，而第五次试验需要18.0（2.1）分钟。除第三次和第四次试验之间外，均具有统计学意义。随着操作频率增加，整体评分量表有改善。第一次试验的平均总分（满分30分）为8.9（1.5），提高到了25.0（0.9）。至于缝合错误，第一次试验记录到7.5（1.3）处错误，第五次试验减少到1.6（0.7）处。
作者采用了一种在传统评估研究中加入时间因素的方案进行显微外科训练。使用猪腿进行显微外科实践在统计学上节省了时间，并提高了包括5次端端动脉吻合练习的3次完整操作的技能。这是一种培养吻合手术中基本技术的有效且经济的方法。
