Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK; Group for Academic Plastic Surgery, The Blizard Institute, Queen Mary University of London, London, UK.
Department of Plastic Surgery, St. George's Hospital, London, UK.
J Plast Reconstr Aesthet Surg. 2019 Feb;72(2):203-210. doi: 10.1016/j.bjps.2018.10.021. Epub 2018 Nov 2.
Microvascular anastomosis with coupler devices has revolutionized microsurgery practice. Couplers are considered easier to apply and offer improved operating time while maintaining success rates. This study aims to map the learning curve, skill acquisition, and decay of novice microsurgeons in performing coupler anastomosis.
Novice microsurgeons performed consecutive coupler applications on a three-layer silastic vessel in two phases. Overall time, total movements, and total path-length were objectively measured and the overall surgical performance was calculated using hand motion analyzer (Dextrous MD, Inition, London, UK).
Sixty coupler anastomoses were performed using the synthetic, three-layered silicone vessel by 5 novices, 40 for phase 1, 12 for phase 2 and 8 for phase 3. During the phase 1 and phase 2 learning curves deliberate practice, the novices required an average of 8 (6-9) and 4 (2-6) consecutive repetitions, respectively, before reaching the experts' performance. There was an average improvement of 69% (p < 0.001) from their baseline performance during phase I and 37% (p < 0.001) during phase II. End-product assessment revealed that 4 out of 40 coupler applications during phase 1 (10%), 3 out of 20 during phase 2 (15%), and 1 out of 8 during exit performance-phase 3 (12.5%). During phase 3 end-product assessment with f-cMP, 7 out of 8 arterial and venous coupler anastomoses demonstrated an adequate range of flow measures.
This study demonstrated objectively learning curves and skill decay following a suggested coupler application curriculum and quantified objective thresholds for ethical animal model training and safe supervised clinical sessions in the OR.
微血管吻合器的出现彻底改变了显微外科的实践。与传统方法相比，吻合器更容易操作，可缩短手术时间，同时保持成功率。本研究旨在绘制新手在使用吻合器进行吻合时的学习曲线、技能获取和衰退情况。
新手在两个阶段连续使用三层硅树脂管进行吻合器吻合。使用手部运动分析器（Dextrous MD，Inition，London，UK）客观测量总时间、总运动次数和总路径长度，并计算总体手术表现。
5 名新手使用合成的三层硅树脂管进行了 60 次吻合器吻合，其中 40 次用于第 1 阶段，12 次用于第 2 阶段，8 次用于第 3 阶段。在第 1 阶段和第 2 阶段的学习曲线（刻意练习）中，新手分别需要平均 8（6-9）和 4（2-6）次连续重复，才能达到专家的水平。与基线相比，第 I 阶段的平均提高了 69%（p<0.001），第 II 阶段提高了 37%（p<0.001）。最终产品评估显示，第 1 阶段有 40 次吻合器应用中有 4 次（10%），第 2 阶段有 20 次中有 3 次（15%），第 3 阶段有 8 次中有 1 次（12.5%）。在第 3 阶段的 f-cMP 最终产品评估中，8 个动脉和静脉吻合器中有 7 个显示出足够的流量测量范围。
本研究客观地展示了学习曲线和技能衰退，遵循了吻合器应用课程，并量化了伦理动物模型训练和安全监督临床手术的客观阈值。
