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1.
Ann Otol Rhinol Laryngol ; 129(2): 101-109, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31522512

RESUMO

OBJECTIVE: To assess the prevalence of microlaryngeal teaching course in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs in an effort to evaluate the nature, perceived value and barriers to implementation of microlaryngeal courses. METHOD: A 14-question survey to all ACGME-accredited otolaryngology programs in the United States. RESULT: Out of 119 ACGME-accredited otolaryngology programs identified on the ACGME Fellowship and Residency Electronic Interactive Database, responses were received from 67 programs (56%). Although 90% of respondents indicated that instruction courses in one discipline or another existed at their institution for their otolaryngology residents, only 33% indicated that their program offers a hands-on instruction course in microlaryngeal surgery. Of those programs that offered a microlaryngeal surgery course, 100% felt the residents appreciated the course; 95% of those programs that did not have a course felt their residents would appreciate a microlaryngeal course at their institution if they were able to offer one. Among programs without a microlaryngeal teaching course, the largest perceived barriers were cost and availability of appropriate equipment. CONCLUSION: Microlaryngeal courses for otolaryngology residency training are limited in availability in the United States, and there is variability in training across the country. All respondents in our survey indicated the value in these courses for microlaryngeal surgical skill training. There is a clear role for increasing availability of low-cost microlaryngeal stations and courses.


Assuntos
Dissecação/educação , Internato e Residência/métodos , Laringe/cirurgia , Otolaringologia/educação , Acreditação , Currículo , Humanos , Microcirurgia/educação , Inquéritos e Questionários , Estados Unidos
2.
J Surg Oncol ; 121(1): 8-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31309553

RESUMO

The hands-on supermicrosurgery course provided participants a valuable learning experience of in-depth practices of supermicrosurgical skills with experts. Seven live surgeries were successfully demonstrated at 8th World Symposium for Lymphedema Surgery. Variable donor sites for vascularized lymph node transfer were the submental, supraclavicular, groin, and omental; while the recipient sites included the wrist and axilla in upper limb; and popliteal and groin in the lower limb. The therapeutic and preventive lymphovenous anastomosis was also satisfactorily performed.


Assuntos
Linfedema/cirurgia , Microcirurgia/educação , Microcirurgia/métodos , Adulto , Idoso , Feminino , Humanos , Linfedema/diagnóstico , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Curr Opin Ophthalmol ; 31(1): 74-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31770166

RESUMO

PURPOSE OF REVIEW: To review various techniques of manual small incision cataract surgery (MSICS), updates on training residents and fellows, and cost-effectiveness of the surgery. RECENT FINDINGS: Recent population studies estimate that there are 53 million people blind worldwide from cataracts, up from previous figures. This is in part because of population growth and increased life expectancy worldwide. MSICS continues to play a significant role in addressing cataract burden and there is an increasing need to train surgeons in the technique. In response to this need, several modules and rubrics have been developed to assist in the training process. SUMMARY: MSICS has been refined over recent decades with overall outcomes comparable to phacoemulsification (phaco) in certain settings. MSICS cost and efficiency advantages support its ongoing essential role in addressing global cataract blindness.


Assuntos
Extração de Catarata/métodos , Microcirurgia/métodos , Extração de Catarata/economia , Extração de Catarata/educação , Análise Custo-Benefício , Educação de Pós-Graduação em Medicina , Humanos , Internato e Residência , Microcirurgia/economia , Microcirurgia/educação , Ferida Cirúrgica
4.
Cir. plást. ibero-latinoam ; 45(4): 405-412, oct.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186029

RESUMO

Introducción y objetivo: El éxito de un colgajo microquirúrgico depende, entre otras cosas, de una correcta técnica de la anastomosis, siendo la experiencia preoperatoria del cirujano directamente proporcional a la tasa de supervivencia del mismo. El uso de animales vivos es el modelo estándar para el entrenamiento en Microcirugía. Sin embargo, implica un alto costo y una necesidad de recursos. Existen diferentes alternativas para el entrenamiento de habilidades microquirúrgicas pero sigue siendo necesario tener un microscopio y un lugar físico para realizar las prácticas. El uso de teléfonos inteligentes en Cirugía Plástica toma cada vez más relevancia y hoy en día son varias sus aplicaciones también como alternativa al microscopio. El objetivo de este trabajo es proponer un modelo alternativo para la enseñanza microquirúrgico utilizando un teléfono inteligente como sustituto del microscopio. Material y método: Creamos una plataforma de trabajo sobre una mesa con un soporte de celular con brazo flexible al costado de la misma. Para reemplazar el microscopio utilizamos un teléfono inteligente Apple 8s Plus(R) que permite un zoom digital de hasta 10X y la posibilidad de grabar videos en 4k y alta definición. Para las pruebas planteamos 3 ejercicios con modelos inanimados de dificultad creciente: el deshilachado de las fibras de una gasa, el armado de suturas en un guante de látex y la técnica de anastomosis vascular y/o nerviosa en una pata de pollo. Tomamos fotografías en las diferentes magnificaciones para comprobar la definición y la posibilidad de realizar anastomosis sobre diferentes plataformas. Resultados: Pudimos realizar los 3 ejercicios utilizando la máxima magnificación con una definición adecuada. Conclusiones: El teléfono inteligente permite realizar diferentes ejercicios microquirúrgicos con un adecuado nivel de magnificación y definición. Podría por tanto emplearse como sustituto y/o complemento del microscopio para una práctica más accesible y económica


Background and objective. A successful outcome in Microsurgery depends, among others, on the performance of technically perfect microvascular anastomosis, being the operative experience the single most critical factor in avoiding free flap failure. Using living animals represents the actual training standard. However, this implies high costs. Several nonliving models have been proposed as alternatives for the acquisition of basic skills. Nevertheless, a microscope is needed to practice. The use of smartphones in Plastic Surgery is well documented. The purpose of this article is to describe the possibility of using the smartphone to replace an operating microscope in Microsurgery training. Methods. A test platform was created. A phone holder was placed on the side of a table, such that it could be comfortably reached from the test platform. The microscope was replaced with a smartphone Apple 8s Plus(R) with a digital 10x zoom. Three exercises in non living models were used for the test: gauze, latex glove and chicken tight. Photographs were taken to show the smartphone definition and the applicability to perform Microsurgery anastomosis. Results. All exercises could be performed in the maximum magnification with adequate definition. Conclusions. The use of smartphones as a microsurgery model presented in this study could be applied to basic Microsurgery education and also used as an alternative training model owing to its easy application, easy accessibility and low cost


Assuntos
Smartphone/instrumentação , Smartphone/tendências , Microcirurgia/educação , Microcirurgia/tendências , Gravação em Vídeo/instrumentação , Microcirurgia/instrumentação , Cirurgia Plástica/educação
5.
Handchir Mikrochir Plast Chir ; 51(6): 477-483, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698489

RESUMO

Microsurgical training is organised almost exclusively in a post-graduate setting, usually for residents of various surgical specialities. The aim of this study was to present an undergraduate microsurgical training model directed toward medicine students of clinical years. Curriculum design and results. Two six-participant groups of students interested in training were recruited. The programme consisted of 15 three-hour classes (2 hours' work under the microscope) and divided into basic and advanced training parts. The simulation model used in this course was a chicken thigh. The basic training programme consisted of placing sutures on a latex glove followed by preparation of a chicken thigh neurovascular bundle and performing femoral nerve and artery anastomoses. The advanced part of the training consisted of practising the acquired skills and the introduction of new techniques such as end-to-side arterial anastomosis, artery and nerve repair with vein conduit. A "6-stitches test" was used as an outcome measure of the acquired microsurgical skills. After 15 weeks and 30 hours of training and performing 31 anastomoses the undergraduate microsurgical course was completed. CONCLUSION: The results of this study show that the undergraduate, facultative microsurgical training is effective in acquiring microsurgical skills, competence and confidence for participating students.


Assuntos
Competência Clínica , Currículo , Educação de Graduação em Medicina , Microcirurgia , Artérias , Humanos , Microcirurgia/educação , Estudantes
6.
Hand Surg Rehabil ; 38(6): 353-357, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31589934

RESUMO

This study was done using an educational tool called the "Micro-Clock", which was inspired by Chan's "round-the-clock" training model. The Micro-Clock consisted of a surgical sponge on which 12 sewing needles were configured in the shape of a clock. The subjects were asked to thread a small suture through the eyelets as quickly as possible. Steadiness and instrument manipulation were evaluated during each trial and graded from 1 to 3. The execution time was measured in seconds. Fifteen instructors did the Micro-Clock test once in order to validate this tool's ability to assess the skills of qualified microsurgeons. Next, nine students, who were enrolled in a microsurgery diploma program, did the test nine times during the program to measure their progression and to evaluate their mastery and execution speed. There was no significant differences among the three instructor sub-groups (residents, assistants and senior surgeons) in their steadiness, instrument manipulation and execution time. When the students performed the Micro-Clock test, there was a significant improvement in movement fluidity as well as the execution time between the first and ninth test. Nevertheless, the execution time did not improve further after the fourth test. The Micro-Clock is a useful and reliable tool for teaching microsurgery skills and testing the maintenance of skills in qualified microsurgeons.


Assuntos
Avaliação Educacional/métodos , Microcirurgia/educação , Competência Clínica , Humanos , Reprodutibilidade dos Testes , Treinamento por Simulação
7.
World Neurosurg ; 132: 188-196, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476454

RESUMO

INTRODUCTION: Three-dimensional (3D) imaging and videos are a very useful tool in the neurosurgical training, although unfortunately the 3D systems available have a very high cost. The objective of this study is to describe a novel and low-cost 3D microsurgical video system. METHODS: To obtain the 3D videos we use a surgical microscope, 2 video adapters, 2 cameras, and an HDMI cable. A video editor program is used for processing the videos. For the projection we use a computer with PowerPoint (Microsoft, Inc, Redmond, WA) software, a video splitter, DVI cables, 2 projectors, 2 polarization filters, and a "silver screen" with polarized glasses. RESULTS: By using 2 equal cameras and video adaptors in each beam splitter port it was possible for us to obtain 2 videos that were equivalent to the images received by both surgeon's eyes. Using the video signal of both cameras during processing resulted in a 3D stereoscopic recording with Final Cut (Apple, Inc, Cupertino, CA) software. The polarized 3D format provided the best projection conditions. It does not alter the original colors of the videos and its prolonged visualization was more comfortable. The main advantage of this method is the ability to show in a realistic way the spatial relationships and the depth of the structures captured with the microscope. CONCLUSIONS: This paper presents in a clear and detailed way how to create and use a low-cost 3D surgical video system.


Assuntos
Microcirurgia/educação , Neurocirurgia/educação , Gravação em Vídeo , Humanos , Imagem Tridimensional , Microscopia , Microcirurgia/instrumentação , Software
8.
Hand Surg Rehabil ; 38(6): 348-352, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31473335

RESUMO

Our hypothesis was that immediate repetition of a microsurgery-suturing task will improve its execution and outcome. This was an experimental animal study. Ten surgeons were divided into two groups of five surgeons. Each performed two end-to-end carotid anastomoses on the same rat, one after the other. The anastomosis was evaluated by the surgeon and an instructor. The primary endpoint was permeability. The outcome was evaluated using an objective and subjective assessment grid yielding 1 to 3 points per item. The total scores for each of the 10 surgeons were used to compare the anastomosis of carotid 1 versus 2, using the ratings given by the surgeon and the instructor. Twenty anastomoses were performed, but 1 rat died intraoperatively, leaving 18 anastomoses for evaluation. No significant differences were found on the main endpoint of permeability, with all anastomoses being permeable. The surgeon's self-assessment was significantly better for the second carotid artery (P=0.05), but this was not confirmed by the proxy assessment (instructor). The analysis by subgroups-morning versus afternoon-found the second carotid anastomosis was significant better in the self-assessment and proxy assessment for the morning group (P<0.001, P=0.024). There was no significant difference in clamping times. The immediate repetition of a microsurgical procedure seems to favor its execution, which leads us to propose that the more difficult or important anastomosis should be done after an easier or less important one during complex surgeries. LEVEL OF EVIDENCE: 2B.


Assuntos
Anastomose Cirúrgica/educação , Competência Clínica , Educação Médica Continuada/métodos , Microcirurgia/educação , Cirurgiões , Suturas , Animais , Artérias Carótidas/cirurgia , Humanos , Ratos Sprague-Dawley , Grau de Desobstrução Vascular
9.
Plast Reconstr Surg ; 144(3): 496e-507e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461050

RESUMO

BACKGROUND: Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. METHODS: A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria. RESULTS: Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators. CONCLUSIONS: A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.


Assuntos
Educação Baseada em Competências/métodos , Microcirurgia/educação , Procedimentos Cirúrgicos Reconstrutivos/educação , Treinamento por Simulação/métodos , Cirurgia Plástica/educação , Competência Clínica , Currículo , Humanos , Internato e Residência/métodos , Modelos Anatômicos , Próteses e Implantes , Cirurgiões/educação , Realidade Virtual
10.
Int Braz J Urol ; 45(5): 1013-1019, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268638

RESUMO

OBJECTIVES: to validate an experimental non-animal model for training of vasectomy reversal. MATERIALS AND METHODS: The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software. RESULTS: Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035). CONCLUSION: The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.


Assuntos
Modelos Anatômicos , Vasovasostomia/educação , Análise de Variância , Lista de Checagem , Competência Clínica , Humanos , Masculino , Microcirurgia/educação , Impressão Tridimensional , Reprodutibilidade dos Testes , Silício , Estatísticas não Paramétricas , Fatores de Tempo , Ducto Deferente/cirurgia
11.
Br J Oral Maxillofac Surg ; 57(7): 616-619, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31239227

RESUMO

As training in microvascular surgery often involves the use of live animals, it is important that such a practice is regularly revisited and justified, particularly in the context of emerging training strategies such as virtual simulation. This systematic review was therefore designed to assess the ongoing need for their use over other methods. A search of PubMed and MEDLINE using the major MeSH terms: anastomosis, surgical vascular procedures, microsurgery, and training, yielded 1386 titles from which 153 abstracts were read, 70 papers analysed, and 17 included. Nine of these papers were randomised studies that compared different methods of training. Other publications were included if the use of live animals was assessed or commented upon, or both (8 publications). Only one study randomised trainees to a non-living animal model or a living model, with detailed assessment that included clinical transfer to live surgery. It showed no significant difference in the quality of training, and excellent techniques of assessment. There was much discussion on the advantage of regular training and opportunities to practise without tuition, but there was no clear advantage for the use of live animals. Our review emphasises the lack of evidence regarding the need for live animals in the training of microsurgical or microvascular skills. Although the assumption remains that the use of live rats is essential, there is a clear need for a high-quality, comparative study to justify the continued use of such models given the quality of the alternatives now available.


Assuntos
Competência Clínica , Microcirurgia/educação , Procedimentos Cirúrgicos Vasculares/educação , Anastomose Cirúrgica , Animais , Modelos Animais , Ratos
12.
World Neurosurg ; 130: e112-e116, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31176838

RESUMO

INTRODUCTION: Quality assurance (QA) is a way to prevent mistakes in advance. Although it has been previously reported for surgical setup, there is no effective approach for minimizing microsurgical technical errors before an operation is done. Neurosurgery resident operative errors during brain aneurysm surgery could be foreseen by practicing in an ex vivo hybrid simulator with microscopic fluorescein vessel flow image. METHODS: Five vascular neurosurgeons and 8 junior/senior neurosurgical residents voluntarily joined this research initiative. The following methodology was adopted: 1) Identification of the 7 most-common resident operative performance errors during brain aneurysm surgery; 2) Design of exercises to prevent common mistakes in brain aneurysm microsurgery using a placenta simulator; and 3) Blinded staff neurosurgeon evaluation of resident performance during real brain aneurysm microsurgery. RESULTS: All key steps to perform such intervention were accomplished with a simulator that uses 2 placentas, a synthetic cranium, and microscopic fluorescein vessel flow image. Neurosurgery residents trained in this model had better surgical performance with fewer perioperative mistakes (P < 0.05). Fine microsurgical dissection of the arachnoid membrane and aneurysm sac were the most commonly improved tasks among the 7 common operative mistakes. Brain parenchyma traction with secondary bleeding was the only error not prevented after previous simulator training. CONCLUSIONS: There was a left-shift on the quality assurance line with residents who practiced brain aneurysm microsurgical errors in an ex vivo model. A multicentric prospective study is necessary to confirm the hypothesis that real operative error could be reduced after training in a realistic simulator.


Assuntos
Aneurisma Intracraniano/cirurgia , Microcirurgia/educação , Microcirurgia/normas , Neurocirurgia/educação , Neurocirurgia/normas , Procedimentos Neurocirúrgicos/educação , Procedimentos Neurocirúrgicos/normas , Competência Clínica , Humanos , Internato e Residência , Microcirurgia/efeitos adversos , Neurocirurgiões , Procedimentos Neurocirúrgicos/efeitos adversos , Garantia da Qualidade dos Cuidados de Saúde , Treinamento por Simulação
13.
World Neurosurg ; 130: 59-64, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31238170

RESUMO

BACKGROUND: Microscopic training is essential for development of neurosurgical skills. A range of models is reported in the literature for this purpose, including live animals, exvivo, and synthetic material. Among the factors involved in selection and development of a training station, cost is a decisive one. METHODS: We present a low-cost model to practice microvascular anastomoses using a bovine heart and an artificial perfusion system. We also present a brief review of laboratory models for microsurgical training, focusing on the costs and reproducibility of the different options. RESULTS: Exvivo models are a great bridging point between nonbiologic and living animal training models. These models have major similarities to human vessels, such as lumen size and malleability of the arteries. The bovine heart model allowed the residents to gain confidence in handling vascular tissue in a microscopic environment. CONCLUSIONS: Although these models do not resemble anatomic landmarks in the human brain, the bovine heart model allowed the residents to gain confidence in handling vascular tissue in a microscopic environment.


Assuntos
Análise Custo-Benefício , Coração/anatomia & histologia , Microcirurgia/educação , Modelos Anatômicos , Modelos Animais , Neurocirurgiões/educação , Animais , Bovinos , Humanos , Internato e Residência/economia , Internato e Residência/métodos , Microcirurgia/economia , Neurocirurgiões/economia
15.
J Plast Surg Hand Surg ; 53(5): 279-287, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31066601

RESUMO

The main aim of the present report is to describe our learning curve in microsurgery and how we solved the problems that frequently occur during the first phases of this learning curve. We analyzed the medical records of 69 patients that underwent head and neck reconstruction with free flaps in our department. The patients were divided into two groups. Group 1 included the patients reconstructed between January 2011 and June 2017, whilst Group 2 included those reconstructed between July 2017 and August 2018. A χ2 test was used to compare the differences between the two groups in terms of flap failure (failure and partial failure) and eventual clinical errors. The p value was set at 0.05. Flap failure and clinical errors were most frequently observed in Group 1 (p < 0.05). Greater awareness of the need for proper functioning of the anastomosis during surgery, along with more exhaustive postoperative monitoring might explain the lower number of failures and signs of vascular compromise observed in Group 2. A number of variables may influence flap survival. Postoperative care, head position, kinking, body temperature, blood pressure and the ability to recognize the sign of vascular compromise all play a fundamental role following surgery. However, microsurgery is not just a routine type of surgery, and a properly trained team with several types of professionals must be adequately prepared to obtain acceptable results.


Assuntos
Retalhos de Tecido Biológico , Sobrevivência de Enxerto , Curva de Aprendizado , Microcirurgia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Idoso , Traumatismos Faciais/cirurgia , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Microcirurgia/educação , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Bucais , Osteorradionecrose/cirurgia , Sistemas Automatizados de Assistência Junto ao Leito , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Fluxo Sanguíneo Regional , Ultrassonografia Doppler , Adulto Jovem
16.
J Otolaryngol Head Neck Surg ; 48(1): 19, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072392

RESUMO

BACKGROUND: There is a lack of published literature on the training in microvascular reconstructive techniques in facial plastic and reconstructive surgery (FPRS) fellowships or of the extent these techniques are continued in practice. This cross-sectional web-based survey study was conducted to describe the volume, variety, and intended extent of practice of free tissue transfers during fellowship and the post-fellowship pattern of microsurgical practice among FPRS surgeons in various private and academic practice settings across the United States. METHODS: This survey was sent to recent graduates (n = 94) of a subset of U.S. Facial Plastic and Reconstructive Surgery fellowship programs that provide significant training in microvascular surgery. RESULTS: Among survey respondents (n = 21, 22% response rate), two-thirds completed 20-100 microvascular cases during fellowship using mainly radial forearm, fibula, anterior lateral thigh, latissimus and rectus free tissue transfers. In post-fellowship practice, those who continue practicing microvascular reconstruction (86%) complete an average of 33 cases annually. The choice of donor tissues for reconstruction mirrored their training. They are assisted primarily by residents (73%) and/or fellows (43%), while some worked with a micro-trained partner, surgical assistant, or performed solo procedures. Interestingly, among those who began in private practice (29%), only half remained with that practice, while those who joined academic practices (71%) largely remained at their initial post-fellowship location (87%). CONCLUSIONS: These results provide the first formal description of the training and practice patterns of FPRS-trained microvascular surgeons. They describe a diverse fellowship training experience that often results in robust microvascular practice. The maintenance of substantial microsurgical caseloads after fellowship runs counter to the perception of high levels of burnout from free tissue transfers among microvascular surgeons. TRIAL REGISTRATION: This study was approved as exempt by the University of Florida Institutional Review Board (#201601526).


Assuntos
Internato e Residência , Microcirurgia/educação , Padrões de Prática Médica , Procedimentos Cirúrgicos Reconstrutivos/educação , Cirurgia Plástica/educação , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Estudos Transversais , Bolsas de Estudo , Retalhos de Tecido Biológico , Humanos , Inquéritos e Questionários
17.
Appl Ergon ; 77: 40-49, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30832777

RESUMO

We investigated the learning of fine manual dexterity with a microsurgical instrument and a new simulator in a context of microsurgery. 30 subjects were divided into two groups. One (3D group) interacted with a stereoscopic and the other (2D group) with a monoscopic display. Visual information for the displays was captured from a surgical stereomicroscope. In 20 trials, both groups performed the repetitive tasks of picking up small rods from a funnel-shaped cavity and placing them outside. In analysing learning curves, we found that the initial learning process for hand-eye coordination is easier with a 3D display, and that performance persists at a higher level of proficiency than with the 2D display option. Thus stereoscopic displays can be especially beneficial for novices, for those learning new procedures, or for providing orientation to operators facing a new or altered spatial situation. Simulators with few reliefs or spatial textures should not be used for comparison between 3D and 2D viewing conditions.


Assuntos
Percepção de Profundidade , Processamento de Imagem Assistida por Computador/métodos , Laparoscopia/educação , Microcirurgia/educação , Treinamento por Simulação/métodos , Adulto , Competência Clínica , Feminino , Humanos , Aprendizagem , Masculino
18.
J Craniofac Surg ; 30(3): e213-e216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845093

RESUMO

INTRODUCTION: Microsurgical interposition of vein grafts is an extraordinarily filigree surgical technique, which requires both sound theoretical knowledge and solid manual skills. Although there are a large number of training models, the majority of these are either relatively expensive, technically complex, or employ synthetic materials with poor resemblance to human tissue. The authors' model allows training of ex vivo vein graft interposition on gradually thawed cryopreserved vessels and it, therefore, is cost-efficient and readily available when needed. Furthermore, it respects the 3R-principle (Reduce-Refine-Replace), as it is based on rat cadaveric vessels. METHODS: Three trainees with basic microsurgical experience, but without prior performance of vein graft interpositioning, were chosen to perform 20 femoral vein graft (5 mm) interpositions into femoral artery defects. The patency and leakage rate served as qualitative variable and operation time as a quantitative variable for efficiency control. RESULTS: For the first half of trials, the trainees had a patency failure rate of 50% and for the second half a rate of 13.3%. The leakage rate noticeably decreased from 44.4% in the first half of trials to 10% in the second half. Although the trainees needed 60 minutes on average for their first 10 trials, they improved to 51 minutes for their last 10 anastomoses. CONCLUSION: The authors' microsurgical model offers a simple, low-cost simulation training, specifically designed for learning of vein graft interposition into arterial defects. The model is associated with a high learning curve, based on an objective control of the anastomoses by assessment of the patency, leakage, and operation time.


Assuntos
Criopreservação , Microcirurgia/educação , Enxerto Vascular/educação , Animais , Artéria Femoral/fisiologia , Artéria Femoral/cirurgia , Veia Femoral/fisiologia , Veia Femoral/transplante , Humanos , Modelos Educacionais , Ratos
19.
J Reconstr Microsurg ; 35(7): 499-504, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30836413

RESUMO

BACKGROUND: End-to-end, end-to-side, and side-to-side microvascular anastomoses are the main types of vascular bypass grafting used in microsurgery and neurosurgery. Currently, there has been no animal model available for practicing all three anastomoses in one operation. The aim of this study was to develop a novel animal model that utilizes the rat abdominal aorta (AA), common iliac arteries (CIAs), and the median sacral artery (MSA) for practicing these three types of anastomosis. METHODS: Eight adult Sprague-Dawley rats were anesthetized and then laparotomized. The AA, MSA, and bilateral CIAs were exposed and separated from the surrounding tissues. The length and diameter of each artery were measured. The relatively long segment of the AA without major branches was selected to perform end-to-end anastomosis. One side of the CIAs (or AA) and MSA were used for end-to-side anastomosis. The bilateral CIAs were applied to a side-to-side and another end-to-side anastomosis. RESULTS: Anatomical dissection of the AA, CIAs, and MSA was successfully performed on eight Sprague-Dawley rats; four arterial-to-arterial anastomoses were possible for each animal. The AA trunk between the left renal artery and right iliolumbar arteries was 15.60 ± 0.76 mm in length, 1.59 ± 0.15 mm in diameter, for an end-to-end anastomosis. The left CIA was 1.06 ± 0.08 mm in diameter, for an end-to-side anastomosis with the right CIA. The MSA was 0.78 ± 0.07 mm in diameter, for another end-to-side anastomosis with the right CIA or AA. After finishing end-to-side anastomosis in the proximal part of bilateral CIAs, the distal portion was juxtaposed for an average length of 5.6 ± 0.25 mm, for a side-to-side anastomosis. CONCLUSION: This model can comprehensively and effectively simulate anastomosis used in revascularization procedures and can provide more opportunities for surgical education, which may lead to more routine use in microvascular anastomosis training.


Assuntos
Anastomose Cirúrgica/educação , Microcirurgia/educação , Procedimentos Cirúrgicos Vasculares/educação , Animais , Masculino , Modelos Animais , Ratos , Ratos Sprague-Dawley
20.
Fertil Steril ; 111(3): 444-453, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827518

RESUMO

Men seeking fertility after elective sterilization can be treated with a wide array of interventions. Reconstruction of the reproductive tract remains the gold standard and most cost-effective option for the appropriately selected candidate. In the following review, the treatment algorithm for men desiring vasectomy reversal is outlined. Specifically, the current evidence basis for preoperative evaluation, intraoperative decision making, postsurgical management, and emerging advances to optimize outcomes will be discussed. Finally, the important role of microsurgical training and how the field can improve quality of care will be reviewed.


Assuntos
Microcirurgia , Vasovasostomia/métodos , Competência Clínica , Tomada de Decisão Clínica , Educação de Pós-Graduação em Medicina , Fertilidade , Humanos , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/educação , Recuperação de Função Fisiológica , Resultado do Tratamento , Vasovasostomia/efeitos adversos , Vasovasostomia/educação
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