gms | German Medical Science

Objectives/Interrogation: Microsurgery is an intricate surgical skill that requires fine movements with a high level of hand-eye coordination. Residents in hand surgery must successfully acquire microsurgical skills via repeated practice in order to attain skills that will enable them to achieve vascular patency in patients. As residents, few have the opportunity during their training duration to perform microsurgery in patients on a regular basis as a primary surgeon. There is hence a need for residents to practice in a non-clinical setting in order to improve their skills. However, there is scarce literature that objectively tracks a resident's improvement in microsurgical skills with practice outside a clinical setting. Our hypothesis is that the microsurgical skills of residents will improve with regular practice over time, in terms of ability to place sutures accurately, consistency of suturing and duration taken.

Methods: 4 residents at different stages of training in the Hand Surgery Residency Program at National University Hospital participated in the study, which spanned across 18 sessions with the residents being evaluated in each session. The task set in each session was to place 9 sutures in a prefabricated 4mm elastic strip under the microscope. A previously validated computer program from Digital Surgicals was used to objectively assess the strips - the spacing between the sutures placed (band score); and the spacing between each suture and wound (deviation score) were measured to give a total score out of 35. The duration taken to place 9 sutures in each strip was also recorded.

Results and Conclusions: Not only did all residents demonstrated improvement in their total scores over 18 sessions, their scores also showed increased consistency, reduced variability and the residents all took a shorter duration to carry out the same task at the end of the 18 sessions. Residents who are more advanced in their training, with more years of microsurgical exposure, attained higher mean scores with reduced variability.

This study is the first of its kind to objectively track improvements of microsurgical skills in residents at regular intervals over a prolonged period of time, with the use of a validated computer program. The findings of this study hence justifies the need for regular microsurgical practice outside of a clinical setting.