Microneurosurgical Skills Training.

Microneurosurgical operations differ from other surgery. Longer operative time, narrow and deep-seated operative corridors, hand-eye coordination, fine manipulation, and physiologic tremor present special problems. Proper understanding of visual feedback, control of physiologic tremor, better instrument design, and development of surgical skills with better precision is important for optimal surgical results. Using the pen-type precision grip with well-supported arm, wrist, hand, and fingers avoids fatigue and improves precision. Proper instrument design, patient positioning, hemostasis techniques, tilting operative table, good operative microscope, an adjustable chair, careful use of suction tube, bipolar forceps, and brain retraction play important roles in microneurosurgery. Sufficient clinical case volume or opportunity during routine operative hours may not be available in the beginning for young neurosurgeons; microsurgical training using various models can enable them to gain experience. Training models using deep-seated and narrow operative corridors, drilling, knot-tying technique, and anastomosis using fine sutures under high magnification can be practiced for skill improvement. Training laboratory and simulation modules can be useful for resident training and skill acquisition. Indigenously made inexpensive models and comparatively less expensive microscopes can be used in resource-constrained situations. The maintenance of microsurgical ability should be preserved by staying active in operative practice. The knowledge of ergonomics, proper training, observing hand movements of skillful surgeons, and the use of operative videos can improve skill. Endoscopic assistance, computer-assisted robot hand technique, and microtechnology can provide access to the smallest areas of the body.