D'Andrea Marcello, Musio Antonio, Colasanti Roberto, Mongardi Lorenzo, Fuschillo Dalila, Lofrese Giorgio, Tosatto Luigino
Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy.
Department of Ferrara - Neurosurgery, Sant 'Anna University Hospital, Ferrara, Italy.
Front Surg. 2023 Feb 9;10:1048083. doi: 10.3389/fsurg.2023.1048083. eCollection 2023.
Microanastomosis is a challenging technique requiring continuous training to be mastered. Several models have been proposed, but few effectively reflect a real bypass surgery; even fewer are reusable, most are not easily accessible, and the setting is often quite long. We aim to validate a simplified, ready-to-use, reusable, ergonomic bypass simulator.
Twelve novice and two expert neurosurgeons completed eight End-to-End (EE), eight End-to-Side (ES), and eight Side-to-Side (SS) microanastomoses using 2-mm synthetic vessels. Data on time to perform bypass (TPB), number of sutures and time required to stop potential leaks were collected. After the last training, participants completed a Likert Like Survey for bypass simulator evaluation. Each participant was assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT).
When comparing the first and last attempts, an improvement of the mean TPB was registered in both groups for the three types of microanastomosis. The improvement was always statistically significant in the novice group, while in the expert group, it was only significant for ES bypass. The NOMAT score improved in both groups, displaying statistical significance in the novices for EE bypass. The mean number of leakages, and the relative time for their resolution, also tended to progressively reduce in both groups by increasing the attempts. The Likert score expressed by the experts was slightly higher (25 vs. 24.58 by the novices).
Our proposed bypass training model may represent a simplified, ready-to-use, reusable, ergonomic, and efficient system to improve eye-hand coordination and dexterity in performing microanastomoses.
微血管吻合术是一项具有挑战性的技术，需要持续训练才能掌握。已经提出了几种模型，但很少能有效反映真实的搭桥手术；可重复使用的更少，大多数不易获得，而且设置通常相当耗时。我们旨在验证一种简化的、即用型、可重复使用且符合人体工程学的搭桥模拟器。
12名新手神经外科医生和2名专家神经外科医生使用2毫米合成血管完成了8次端端（EE）、8次端侧（ES）和8次侧侧（SS）微血管吻合。收集了进行搭桥手术的时间（TPB）、缝合针数以及停止潜在渗漏所需时间的数据。在最后一次训练后，参与者完成了一份用于评估搭桥模拟器的李克特式调查问卷。使用西北客观微血管吻合评估工具（NOMAT）对每位参与者进行评估。
比较首次和末次尝试时，两组在三种微血管吻合类型中的平均TPB均有改善。新手组的改善在统计学上始终具有显著性，而专家组仅在ES搭桥手术中有显著性改善。两组的NOMAT评分均有所提高，在新手组中EE搭桥手术具有统计学显著性。随着尝试次数的增加，两组的平均渗漏次数及其解决的相对时间也趋于逐渐减少。专家给出的李克特评分略高（新手为24.58分，专家为25分）。
我们提出的搭桥训练模型可能是一个简化的、即用型、可重复使用、符合人体工程学且高效的系统，可提高微血管吻合术中眼手协调能力和灵活性。
