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Microsurgery May 2017
Topics: Fellowships and Scholarships; Humans; Microsurgery; United States
PubMed: 28334447
DOI: 10.1002/micr.30169 -
European Journal of Trauma and... Feb 2023Microvascular surgery requires highly specialized and individualized training; most surgical residency training programs are not equipped with microsurgery teaching...
PURPOSE
Microvascular surgery requires highly specialized and individualized training; most surgical residency training programs are not equipped with microsurgery teaching expertise and/or facilities. The aim of this manuscript was to describe the methodology and clinical effectiveness of an international microsurgery course, currently taught year-round in eight countries.
METHODS
In the 5-day microsurgery course trainees perform arterial and venous end-to-end, end-to-side, one-way-up, and continuous suture anastomoses and vein graft techniques in live animals, supported by video demonstrations and hands-on guidance by a full-time instructor. To assess and monitor each trainee's progress, the course's effectiveness is evaluated using "in-course" evaluations, and participant satisfaction and clinical relevance are assessed using a "post-course" survey.
RESULTS
Between 2007 and 2017, more than 600 trainees participated in the microsurgery course. "In-course" evaluations of patency rates revealed 80.3% (arterial) and 39% (venous) performed in end-to-end, 82.7% in end-to-side, 72.6% in continuous suture, and 89.5% (arterial) and 62.5% (venous) one-way-up anastomoses, and 58.1% in vein graft technique. "Post-course" survey results indicated that participants considered the most important components of the microcourse to be "practicing on live animals", followed by "the presence of a full-time instructor". In addition, almost all respondents indicated that they were more confident performing clinical microsurgery cases after completing the course.
CONCLUSIONS
Microvascular surgery requires highly specialized and individualized training to achieve the competences required to perform and master the delicate fine motor skills necessary to successfully handle and anastomose very small and delicate microvascular structures. The ever-expanding clinical applications of microvascular procedures has led to an increased demand for training opportunities. By teaching time-tested basic motor skills that form the foundation of microsurgical technique this international microsurgery-teaching course is helping to meet this demand.
Topics: Animals; Humans; Curriculum; Microsurgery; Internship and Residency; Hand; Clinical Competence
PubMed: 35831748
DOI: 10.1007/s00068-022-02040-8 -
World Neurosurgery Apr 2021Stroke microsurgical cerebrovascular thrombectomy reports are limited, although this technique could be used in many centers as a primary treatment or a salvage...
BACKGROUND
Stroke microsurgical cerebrovascular thrombectomy reports are limited, although this technique could be used in many centers as a primary treatment or a salvage intervention option. It requires great ability, so our aim is to describe and validate a stroke microsurgical thrombectomy ex vivo simulator with operative nuances analysis.
METHODS
Human placenta (HP) models simulated middle cerebral artery vessels with intraluminal thrombus to be microsurgically excised. Six neurosurgeons performed 1-mm and 2-mm longitudinal and transverse arteriotomy in different arteries to remove a 1.5-cm length thrombus. Validation through construct validity compared time to complete the task, complete vessel cleaning, vessel manipulation, vessel stenosis, and leakage in both techniques.
RESULTS
All 6 HP models reproduced with fidelity stroke microsurgical thrombectomy, so participants completed 24 sessions, 4 for each neurosurgeon on the same model in different arteries. Construct validity highlighted microsurgical technical difficulties with positive results obtained by parameters variation during performance. Transverse arteriotomy with 1-mm length had best results (P < 0.05) allowing complete thrombus removal, less stenosis, and minor leakage in abbreviated time.
CONCLUSIONS
A HP simulator can reproduce with high fidelity all stroke microsurgical thrombectomy part tasks. Transverse 1-mm arteriotomy followed by thrombectomy and 2 simple sutures can fulfill all quality assurance aspects in such intervention accordingly to training model, due to easier vessel opening, complete thrombus removal, no stenosis, and faster microsuture.
Topics: Clinical Competence; Female; Humans; Microsurgery; Neurosurgeons; Neurosurgical Procedures; Placenta; Pregnancy; Simulation Training; Stroke; Thrombectomy; Vascular Surgical Procedures
PubMed: 33444832
DOI: 10.1016/j.wneu.2020.12.177 -
Journal of Cataract and Refractive... Aug 2014
Topics: Filtering Surgery; Glaucoma; Glaucoma Drainage Implants; Humans; Microsurgery; Stents
PubMed: 25088621
DOI: 10.1016/j.jcrs.2014.06.024 -
Journal of Neurosurgical Sciences Mar 2016After the senior author took chairmanship in Helsinki University Hospital in, he led the department into making neurosurgical operations much faster, safer and workflow... (Review)
Review
After the senior author took chairmanship in Helsinki University Hospital in, he led the department into making neurosurgical operations much faster, safer and workflow more efficient, and at the same time maintaining high surgical quality and results. The aim was to describe the philosophies and style of Helsinki Microneurosurgery. The philosophies of Helsinki Neurosurgery are categorized into two concepts: The operation room TEAM concept and the main principle "Simple, clean, fast and respecting the normal anatomy". The way to be efficient is to find good methods based on logic, reason and experience. Specific and systematic procedures before the microneurosurgery followed by high quality skills under the microscope are of utmost importance. Moreover, intraoperatively, neuroanesthesia has to provide good surgical conditions. Today, Helsinki University Central hospital Department of Neurosurgery has an annual workflow 3500 neurosurgical operations. We believe that microneurosurgical treatment remains to be important for years ahead, and neurosurgeons of great hearts, minds and skills are welcomed all over the world.
Topics: Humans; Microsurgery; Neurosurgical Procedures
PubMed: 26606431
DOI: No ID Found -
Laryngo- Rhino- Otologie Jun 2016The present article gives an overview of the current state of laryngeal surgery of benign lesions without claiming completeness and with a focus on the ENT board exam.... (Review)
Review
The present article gives an overview of the current state of laryngeal surgery of benign lesions without claiming completeness and with a focus on the ENT board exam. Laryngeal procedures are highly endoscopic and microscopic based. New instruments and high-resolution endoscopic imaging techniques may substitute the typical Kleinsasser approach in the near future. Additionally, new flexible endoscopes may initiate a new era of so-called "office-based surgery". Furthermore, a consistent education of the public about performing vocal hygiene is necessary to prevent the rise of laryngeal diseases.
Topics: Ambulatory Surgical Procedures; Equipment Design; Forecasting; Germany; Humans; Laryngeal Diseases; Laryngoscopy; Larynx; Microsurgery
PubMed: 27259173
DOI: 10.1055/s-0042-101848 -
Radiographics : a Review Publication of... 2020Lymphedema, the accumulation of lymphatic fluid in the tissues, is a chronic disease and a major cause of long-term morbidity and disability. Lymphedema is usually a... (Review)
Review
Lymphedema, the accumulation of lymphatic fluid in the tissues, is a chronic disease and a major cause of long-term morbidity and disability. Lymphedema is usually a secondary condition, often caused by prior oncologic therapy, such as surgery for cancers, radiation therapy, and chemotherapy. Treatment for lymphedema has traditionally been conservative and limited, but new surgical and microsurgical procedures have arisen in recent years. Vascularized lymph node transfer (VLNT) is one of the most promising new microsurgeries. VLNT involves the transfer of functional lymph nodes (LNs) from a healthy donor site to an area of the body with damaged or diseased lymphatic drainage. The goal of the transplant is to restore physiologic LN drainage and improve lymphedema. Donor LNs are commonly found in the groin, axilla, neck, omentum, or submental region. Imaging can be used for preoperative planning to identify donor sites with the richest number of LNs. This can help identify those patients who may be candidates for VLNT and can help identify the best anatomic site for surgical harvest in those candidates. Imaging can be performed with US, CT, or MRI. VLNT preoperative imaging often requires acquisition techniques and reconstruction parameters that differ from those used in routine diagnostic imaging. Furthermore, to properly identify target LNs, the radiologist must be aware of surgical anatomic landmarks. RSNA, 2020.
Topics: Anatomic Landmarks; Humans; Lymph Nodes; Lymphedema; Microsurgery
PubMed: 32412827
DOI: 10.1148/rg.2020190118 -
Journal of Reconstructive Microsurgery May 2024Microsurgery is essential in modern reconstructive surgery and plastic surgery training. Surgeon's proficiency and experience are crucial for effective microsurgical...
BACKGROUND
Microsurgery is essential in modern reconstructive surgery and plastic surgery training. Surgeon's proficiency and experience are crucial for effective microsurgical interventions. Despite anecdotal evidence of varying quality of microsurgery training globally, no empirical studies have investigated this. We conducted a global survey to investigate microsurgical training and clinical case exposure among plastic surgery trainees worldwide.
METHODS
An online survey was conducted using a secure platform to gather information on microsurgical case exposure and training among plastic surgery trainees between August 2020 and April 2021. Participants provided consent and completed a 37-question survey across four themes: clinical caseload, surgical exposure to microsurgery, microsurgical simulation training exposure, and barriers and opportunities.
RESULTS
A total of 202 responses were received, with most respondents in formal training programs (86.7%). The data highlighted regional variation in microsurgery case indications and flap types, with North America and Europe exhibiting the highest activity levels in microsurgery. Trainees in Asia have the highest cumulative practical exposure in microsurgery, followed by Australia and Oceania, and North America. Only 39.6% of respondents reported formal microsurgical simulation training, and almost one-third (29.7%) received no simulation training. Trainee access to practical experience is limited by several factors, including insufficient time and procedure complexity. Notably, practical experience was most commonly denied without reason being given.
CONCLUSION
Our study highlights significant disparities in microsurgical training and exposure among plastic surgery trainees globally. Further research is needed to identify strategies for addressing these issues, given the growing demand for complex reconstructive microsurgery and its impact on health care inequalities.
Topics: Humans; Microsurgery; Clinical Competence; Plastic Surgery Procedures; Surgery, Plastic; Surveys and Questionnaires
PubMed: 37643823
DOI: 10.1055/a-2161-8135 -
World Neurosurgery Apr 2021In microneurosurgery, the operating microscope plays a vital role. The classical neurosurgical operation is bimanual, that is, the microsurgical instruments are operated...
BACKGROUND
In microneurosurgery, the operating microscope plays a vital role. The classical neurosurgical operation is bimanual, that is, the microsurgical instruments are operated with both hands. Often, operations have to be carried out in narrow corridors at the depth of several centimeters. With current technology, the operator must manually adjust the field of view during surgery-which poses a disruption in the operating flow. Until now, technical adjuncts existed in the form of a mouthpiece to move the stereo camera unit or voice commands and foot pedals to control other interaction tasks like optical configuration. However, these have not been widely adopted due to usability issues. This study tests 2 novel hands-free interaction concepts based on head positioning and gaze tracking as an attempt to reduce the disruption during microneurosurgery and increase the efficiency of the user.
METHODS
Technical equipment included the Pentero 900 microscope (Carl Zeiss Microscopy GmbH, Jena, Germany), HTC Vive Pro (HTC, Taoyuan District (HQ), Taiwan), and an inbuilt 3D-printed target probe. Eleven neurosurgeons including 7 residents and 4 consultants participated in the study. The tasks created for this study were with the intention to mimic real microneurosurgical tasks to maintain applicative accuracy while testing the interaction concepts. The tasks involved visualization system adjustment to the specific target and touching the target. The first trial was conducted in a virtual reality setting applying the novel hands-free interaction concepts, and the second trial was conducted performing the same tasks on a 3D-printed target probe using manual field of view adjustment. The participants completed both trials with the same predetermined tasks, in order to validate the feasibility of the novel technology. The data collected for this study were obtained with the help of review protocols, detailed post-trial interviews, video and audio recordings, along with time measurements while performing the tasks.
RESULTS
The user study conducted at the Charité Hospital in Berlin found that the gaze-tracking and head-positioning- based microscope adjustment were 18% and 29% faster, respectively, than the classical bimanual adjustment of the microscope. Focused user interviews showed the users' proclivity for the new interaction concepts, as they offered minimal disruption between the simultaneous target selection and camera position adjustment.
CONCLUSIONS
The hands-free interaction concepts presented in this study demonstrated a more efficient execution of the microneurosurgical tasks than the classical manual microscope and were assessed to be more preferable by both residents and consultant neurosurgeons.
Topics: Clinical Competence; Eye-Tracking Technology; Humans; Microsurgery; Neurosurgeons; Neurosurgical Procedures; User-Computer Interface; Virtual Reality
PubMed: 33385607
DOI: 10.1016/j.wneu.2020.12.092 -
Journal of Reconstructive Microsurgery Feb 2018Microsurgery fellowships have become an integral part of every plastic surgery training program. While each subspecialty differs in terms of reconstructive...
BACKGROUND
Microsurgery fellowships have become an integral part of every plastic surgery training program. While each subspecialty differs in terms of reconstructive requirements, the basic tenets and skill sets remain the same. We explore the possibility of designing a clinical curriculum for microsurgery that can provide residents and fellows with a more foundational and structured approach to microsurgical training.
METHODS
Thirteen core and desired skills to accommodate an "ideal" microsurgery curriculum were listed and categorized according to the level of difficulty. The curriculum was then sent to plastic surgery trainees, fellows, and consultants within Scotland in the form of a survey. They were asked to assign a level of difficulty, basic, intermediate, or advanced, to each of the 13 skill sets.
RESULTS
A total of 27 surgeons were surveyed; the majority of which were plastic surgery registrars. Overall a broad, generic clinical curriculum was felt to be lacking, but would be beneficial at the start of training. The curriculum should emphasize a step-wise progression, starting from achieving competency in safe, efficient anastomosis at the basic level to eventually mastering the principles of complex reconstruction at a more advanced level.
CONCLUSIONS
A generic clinical curriculum offers a framework for tracking progress, the potential for competency-based assessment, and aid in designing a microsurgery fellowship. The curriculum should reflect the evolving nature of the specialty and provide a foundational platform for future innovations.
Topics: Clinical Competence; Curriculum; Fellowships and Scholarships; Humans; Microsurgery; Surgery, Plastic
PubMed: 29078227
DOI: 10.1055/s-0037-1607435