Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
J Surg Educ. 2018 Jul-Aug;75(4):1045-1051. doi: 10.1016/j.jsurg.2017.11.003. Epub 2017 Dec 1.
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.
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.
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.
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.
显微外科是最复杂的外科技能之一。然而，与显微外科表现相关的因素尚不清楚。了解这些因素将有助于培训和评估显微外科医生。
共有 29 名参加专门的 1 年制显微外科进修课程的显微外科医师参加了这项研究。在临床评估中，由所有系教员在进修开始、中点和结束时，在手术室中通过多项手术对显微吻合术表现进行评估，使用经过验证的显微评估工具。在实验室评估中，使用 3 种经过验证的显微全球评分量表工具，对每位学员在进修开始和结束时在活体大鼠模型中进行股动脉吻合术的盲法视频记录进行评估。评估了表现与工具评估的因素之间的相关性。
在临床研究中，共有 474 次吻合术评估；临床表现与速度、器械处理和运动相关性最佳。在实验室研究中，共进行了 58 次评估，表现与器械处理、手术流程和手术步骤最密切相关，并且与所花费的时间呈显著负相关。最常见的错误是缝线不对等、握持错误/损伤组织以及结松动。
速度（主观和客观）、器械处理、手术流程和运动与显微吻合术的表现相关。现在需要进行前瞻性试验，以确定这些因素是否应在显微外科技能培训途径的能力定义中得到考虑。
