Using engineering methods (Kaizen-PDCA and Micro-Movements Science) to improve and provide evidence regarding microsurgical hand skills.

ABSTRACT

OBJECTIVE: Microsurgical interventions involve the interaction of numerous variables, making objective analysis of skill proficiency challenging. This difficulty is even more pronounced in low-resource contexts. Continuous improvement methodologies such as Kaizen-PDCA and Micro-Movements Science can address this issue. This study aimed to demonstrate the advantages of designing and implementing microsurgical training programs using these methodologies. METHODS: Following an extensive literature review of Kaizen-PDCA and Micro-Movements Science and under the guidance of experienced neurosurgeons and engineers, a microvascular bypass training program was developed using the human placenta. Subsequently, the training program was used to analyze and describe the process of a trainee neurosurgeon in Argentina with no prior experience in microvascular anastomosis, as the operator gained proficiency. RESULTS: The trainee required 12 attempts to achieve the program goals. The longest procedural time was during the first attempt (1 h 49 min 05 s with two mistakes), while the shortest time was during the fourth attempt (53 min 29 s with three mistakes). After 12 attempts, the trainee made no mistakes, and the procedural time was reduced to 57 min 37 s. The final learning curve demonstrated a regular pattern and reached a plateau after seven attempts. CONCLUSIONS: The training program and methodology effectively assessed, facilitated, and demonstrated the acquisition of microsurgical skills. Kaizen-PDCA and Micro-Movements Science enabled the effective use of expert experience, detailed evaluation of microsurgical procedures, and integration into a continuous improvement cycle. The program structure could also be valuable for teaching, evaluating, and enhancing similar surgical procedures.