Microsurgery is a demanding surgical skillset which requires attention to detail and repeated practice to succeed. Microsurgery courses around the globe allow students to learn through performing a variety of technical exercises. Microsurgery education dates back to the late 1960s with notable instructors, Harry J. Buncke and Robert Acland. Currently, many microsurgery courses are available that share commonalities, and some important structural differences have been demonstrated to differentially affect student progression and competence. Multiple available training programs as well as the advancement of supermicrosurgery training is listed and described.
The microsurgery training course at Columbia University’s New York Presbyterian Irving Medical Center led by Drs. Ronsenwasser, Strauch and Akelina provides students with expert instruction through a punctilious training curriculum. By imparting these techniques to the students, trainees’s progression markedly improves relative to alternative microsurgery courses that do not incorporate expert instruction. The Covid-19 pandemic, has resulted in the development of a virtual microsurgery training program at the lab which focuses on building the foundation of basic skills for trainees unable to travel or receive adequate education.
The paper describes the experience of creating a training course on the basics of microsurgery at the Institute of Microsurgery (Tomsk, Russia). The program of the course is provided, developed in accordance with the World trends in teaching microsurgery. The main trends in the development of educational programs are presented.
Modern technologies and the skills of specialists in reconstructive microsurgery make it possible to solve the problem of restoring the lost cover tissues and bone tissues of the skeleton in one stage with the greatest efficiency, as well as to carry out replantation of limbs or their parts. However, the shortage of such specialists is widely recognized, leading to an increase in disability and death, which account for up to 30% of the global burden of the national health service. In the work, which prepared by specialists from the centres of the cities Dnipro and Kiev, the issue of mastering the skills of reconstructive microsurgery by young specialists is considered. The authors conduct a comparative analysis of teaching methods at two bases in Ukraine and two bases in the European Union.
At the current level of development of international educational programs of a specialized online community (international microsurgery club), it is possible to improve or master new techniques for a surgeon of any level of basic training. According to the price-quality criterion and geographical location, the Pius Branzeu Center laboratory (Romania), in the context of the globalization of the world economy and the integration of the European Union countries, can be considered as optimal centre for teaching basic skills for residents and young doctors. However, after obtaining these skills, the microsurgeon must continue training in the real clinical conditions of existing centres in Ukraine for obtain practical experience.
This paper is dedicated to the memory of Hans Rensema (1948–2020), medical artist of Microsurgical Developments Foundation.
The history of training in microsurgical and experimental techniques in the Netherlands goes back to the 1960s. The training was mostly done on an individual basis. Clinical surgeons could benefit from the 'Wet-Lab' training at the Erasmus University of Rotterdam. Experimental microsurgery and techniques training for larger groups of bio-technicians and researchers started at Utrecht University in 1993, and later at Groningen University. The first commercial training was offered at the International Microsurgical Training Centre in Lelystad (IMTC,) in 2002. This paper presents the current state-of-the-art training in the Netherlands and some future perspectives.
Professor Remie studied Pharmacy at the University of Groningen. After completing his studies in 1983, he specialised in pharmacology and did his PhD on the presynaptic modulation of noradrenergic neurotransmission in the freely moving rat portal vein. He joined Solvay Pharmaceuticals as a Group leader in Pharmacology, specialized (1991) in Laboratory Animal Science (Utrecht University), and became Laboratory Animal Scientist and Animal Welfare Officer of Solvay Pharmaceuticals and Fort Dodge Animal Health Holland. He is chairman of the Microsurgical Developments Foundation and several IACUCs. From 1997 until 2012, he was appointed professor with a special chair in Microsurgery and Experimental Technique in Laboratory Animals at the Groningen Centre for Drug Research, Department of Biomonitoring & Sensoring, University Centre for Pharmacy, University of Groningen. He is CEO of 3-R's Training Centre BV, and Director of the René Remie Surgical Skills Centre (www.rrssc.eu).
Irene Cuesta Cobo earned a BSc in Biology and physiotherapy, and an MSc in manual therapy at the University of Jaén (Spain). She worked at the department of physiology at the same university on an in-vivo assay with gliomas in rats and subsequently, at the Laboratory of CAR Madrid to analyse top athletes' blood samples. She is a senior instructor at RRSSC.
Edwin Spoelstra earned an MSc in Pharmacy and specialised stereotaxic surgery and microdialysis in the rat. He developed several techniques in mice and spent the last ten years on catheter design and blood-sampling.
This describes the UK history of the evolution of microsurgical training. The author has been involved since the start in 1979 and took a sole teaching role in the courses 2 years later. Before teaching microsurgery the necessary skills were obtained by the performance of various organ transplants in mice, rats and rabbits to investigate organ storage and immunosuppression. This experience identified the pitfalls of microsurgery and amplified the then identified need for meticulous microsurgical training. A basic microsurgical program was then instigated to provide step by step exercises of increasing difficulty. This consisted of microscope set-up, correct positioning, instruments, simulated suture exercises, dissection techniques, end to end arterial and venous anastomosis, end to side anastomosis, interpositional vein grafts, nerve anastomosis and groin flaps – all performed on an anaesthetised rat. Latterly we are now running advanced workshops incorporating supramicrosurgical exercises in the chicken (thigh) and the rat. The microsurgical workshops are still running 41 years later!
The need for microscopic vascular anastomosis has increased in the field of gastrointestinal surgery. Herein we report the activities for microsurgical training by ISEM West Japan.
Since 2015, we have held the Hands-on seminar twice a year using artificial blood vessel. The participants sutured it with 9-0 polypropylene suture under bench microscopes. Competitions for microsurgical arterial anastomosis were held in the seminar, in which we evaluated the anastomosis regarding the leakage and patency.
Totally 208 participants attended the hands-on seminar. No relation was seen between the years of surgical experience and the score. However, there was a relation between the number of participation and the score.
Through our hands-on seminar, young surgeon could improve technique and motivation for the microsurgery.
In 2011, the staff of the Department of Plastic Surgery, Sechenov University (Moscow, Russia), organized three-stage microsurgical courses. Having analyzed the advantages and disadvantages of the previous practical course, it was created according to the principle “from simple to complex”, integrating theoretical material into the practical preparation for the formation of a microsurgical outlook.
According to the authors, dividing the learning process into short-term stages allows students to gradually immerse themselves in the microsurgical world, while they themselves regulate the frequency of training and the need for further improvement of skills. Due to the phasing, the course becomes more accessible and makes it possible to popularize microsurgery as a universal method for solving surgical problems.
In the 1980s and 1990s Microsurgery has had a great diffusion in Italy. Our group, who worked in University of Catania, Sicily, got in touch with Sun Lee, the father of Experimental Microsurgery, and applied actively the microsurgical techniques both in the experimental and clinical field.
Several Courses have been organized in Catania to involve young doctors who have been charmed by this new surgical branch.
It is our opinion that in the present time Microsurgery could play an important role in the training of the general surgery residents. An experimental microsurgical training, together with simulators, could guarantee a more complete training of the residents, helping them to be familiar with surgical instruments and suture materials, improving their skill in performing microvascular anastomoses (carotid and femoral arteries) and more complex surgical operations (portocaval shunt) and leading them to a valid research activity.
The Microsurgery began in France in 1972. Since the beginning of many training centers have been created, today we identify 19 places of education throughout the territory. Each training center organizes its own program so we will present here the experience of microsurgery teaching as it is carried out at the «Ecole de chirurgie de l’assistance Publique Hôpitaux de Paris». The microsurgery lab has 44 years experience in microsurgery education and the author has helped set up the programs and their organization and she has been involved in education for over 40 years.
Microsurgery (MS) is a discipline addressed by many specialties and it is our interest to be able to carry out a pedagogical assessment of the Master Degree in Reconstructive Microsurgery (MRM) as a training program in MS.
The MRM is a hybrid, blended program (virtual and face-to-face), developed in 12 modules, over a 2-year duration, which completes 2625 hours. This program is directed by recognized professors in the discipline from different parts of the World and enrolls 35 students per edition.
The program reserves 35% of the places for students from emerging countries. Once each of the modules has been received and the exams passed, the students will undergo a period of clinical immersion in the reference centers around the world and after defending the research project they will be able to receive the distinction of the Master granted by the Autonomous University of Barcelona (UAB).
There have been 11 editions of MRM since 2009 without interruption, with an enrollment of 400 students, 83% received the MRM degree. 65% work as Microsurgeons. 60% were Men and 40%, Women. 32% have become MS leaders in each region.
We consider that the MRM is a solid, reproducible and adaptable program that guarantees each one of the pedagogical aspects. The program is unique and brings together all the qualities so that students have the necessary tools and thus make a safe start in MS.
Ignacio Cifuentes, MD, is a young plastic surgeon from Chile with high interest in microsurgical simulation and training. This paper summarizes some of the work in which the author has collaborated during his plastic surgery residency under the supervision of Bruno Dagnino, MD, as well as some interesting articles regarding microsurgical education in Chile. Francisca Leon, MD, is a microsurgeon and plastic surgeon from Chile with great interest in lower limb reconstruction who collaborated with the development of this review.
Prior to microsurgery practice on patients, microsurgical skills should be learned in a simulated and controlled environment to increase success rates and reduce surgical complications. These favorable environments have historically been the microsurgery laboratories. The use of the experimental animals has allowed surgical trainees to interact with anatomical structures and physiological processes that a microsurgeon has to face in daily clinical scenarios. In recent decades, there has been an increase in simulation methods to reduce the number of animals used for training purposes and thus meet animal welfare criteria.
Spain has a long history in the practice and teaching of microsurgery, this manuscript aims to highlight the importance of first educators, as well as to evaluate the current situation and future perspectives.
The Italian Society for Microsurgery (SIM, Società Italiana di Microchirurgia) developed a 5 steps training program for surgeons from different specialties who want to learn microsurgery as part of their practice. This 5 steps program has been established in 2013 and each course has a unique program and its own logo.
Presently, there are 10 basic courses in Italy recognized by the SIM in Italy. The basic courses have a theoretical part and a practice of at least 20 hours each, performed on an ex-vivo model. There are minimum requirements for each step must be competed to be able to move to the consequent exercise. At the end of the course, each student is evaluated following an extract of the GRS score.
The advanced course is exclusive, it opens to only 20 students each year and involve 35 self-funded tutors.
Тhe program stated by the Italian Society for Microsurgery is very comprehensive and gives the opportunity to young surgeons to learn many aspects of the microsurgical reconstruction.
The aim of this paper is to provide a brief overview of the history of microsurgery in Greece and how it evolved throughout the years. It is based on published literature as well as anecdotal evidence. It is by no means an exhaustive list of available resources and contributions. Microsurgery in Greece begins with Prof Soucacos who acquired his microsurgical skills in the USA (1970–1974), where he worked as a clinical and research fellow. After gaining invaluable experience, he returned to his home country, Greece, to establish a microsurgery replantation team in 1975. His team gained national recognition soon thereafter thanks to the many successes and innovations they achieved. The tradition is continued with contemporary microsurgical courses in Greece from expert faculty and a busy microsurgical practice in several centers across the country. The experimental educational program in microsurgery includes a blend of synthetic and live animal models, such as rats and rabbits. They include a complete exposure to basic and advanced practical exercises through several days. The simulation training models slowly but surely steadily advance to meet the training standards.
