Best David L, Ruggiero Brian L, Bonine Brandon F, Troost Jonathan P, Moe Justine S
Resident, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
Resident, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
J Oral Maxillofac Surg. 2022 Sep;80(9):1564-1572. doi: 10.1016/j.joms.2022.05.005. Epub 2022 May 23.
Oral and maxillofacial surgery residency programs are increasingly adopting microsurgery as a core element of training; however, many barriers exist that limit trainees' proficiency. The purpose of this study was to perform a validation of 2 tabletop microscope simulations for their use as a training tool, which could serve as an affordable, alternative method to traditional microsurgery training methods.
A prospective, single-institution, multidepartmental validation study was performed. Two microscopes (monocular digital [DM] and binocular stereo [SM]) were used to perform anastomoses on simulation vessels including a silastic tube and a chicken thigh femoral artery. A microsurgeon panel was selected from a population of microsurgery faculty and fellows at Michigan Medicine (Ann Arbor, MI) to perform the anastomoses. The surgeons each performed 4 anastomoses, using each microscope with each vessel, and subsequently completed a survey evaluating the simulation. Predictor variables were the microscope and the vessel. Primary outcome variable was readiness for use, which was defined as the simulation's ability to incorporate into a microsurgical training curriculum in its current state. Secondary outcome variables included realism, value, usefulness, relevance, difficulty, and cost. Paired t tests were used to compare responses. Alpha was set to 0.05.
Seven microsurgeons performed the simulation from the departments of oral and maxillofacial surgery (n = 5), plastic and reconstructive surgery (n = 1), and otolaryngology (n = 1). For readiness, the SM simulation required either no modification (n = 4) prior to implementation into a microsurgery curriculum or minimal modification (n = 3), compared to the DM simulation which required significant modification (n = 4) or extensive modification and re-evaluation (n = 3) (P = .002). The SM demonstrated a greater mean realism score than the DM for depth perception (5.00 vs 1.57, P < .001), field of view (4.57 vs 3.57, P = .038), lighting (5.00 vs 4.00, P = .038), and clarity (5.00 vs 3.86, P = .030). There was no statistically significant difference between SM and DM in value, usefulness, relevance, difficulty, or cost.
Tabletop microscopes demonstrate considerable promise in the future of microsurgical education. The SM simulation was a realistic simulation that may be ready for use in a microsurgical curriculum. Future studies are required to demonstrate the efficacy of this simulation on microsurgical trainees.
口腔颌面外科住院医师培训项目越来越多地将显微外科作为培训的核心内容；然而，存在许多限制学员熟练程度的障碍。本研究的目的是对两种桌面显微镜模拟作为培训工具进行验证，这可以作为一种经济实惠的替代传统显微外科培训方法的方式。
进行了一项前瞻性、单机构、多部门的验证研究。使用两台显微镜（单目数字显微镜[DM]和双目立体显微镜[SM]）在包括硅橡胶管和鸡大腿股动脉在内的模拟血管上进行吻合。从密歇根大学医学中心（安阿伯，密歇根州）的显微外科教员和研究员群体中挑选了一个显微外科医生小组来进行吻合。每位外科医生使用每台显微镜对每种血管各进行4次吻合，随后完成一项评估模拟的调查。预测变量是显微镜和血管。主要结局变量是准备好投入使用，定义为模拟在当前状态下纳入显微外科培训课程的能力。次要结局变量包括真实感、价值、有用性、相关性、难度和成本。使用配对t检验比较反应。α设定为0.05。
7位显微外科医生参与了模拟，他们分别来自口腔颌面外科（n = 5）、整形与重建外科（n = 1）和耳鼻喉科（n = 1）。对于准备好投入使用这一点，与需要重大修改（n = 4）或广泛修改及重新评估（n = 3）的DM模拟相比，SM模拟在纳入显微外科课程之前要么无需修改（n = 4），要么只需进行最小程度的修改（n = 3）（P = 0.002）。在深度感知方面，SM模拟的平均真实感得分高于DM模拟（5.00对1.57，P < 0.001）；在视野方面（4.57对3.57，P = 0.038）、照明方面（5.00对4.00，P = 0.038）以及清晰度方面（5.00对3.86，P = 0.030）也是如此。SM和DM在价值、有用性、相关性、难度或成本方面没有统计学上的显著差异。
桌面显微镜在显微外科教育的未来展现出了相当大的前景。SM模拟是一种真实的模拟，可能已准备好用于显微外科课程。未来需要进行研究以证明这种模拟对显微外科受训人员的有效性。
