A Workshop for Training of Basic Neurosurgical Skills "From Microsurgery to Endoscopy": A Stepping Stone for Young Neurosurgeons

Abstract

Background The aim of the project was to show the peculiarities of manipulations in two-dimensional (2D) visualization and to enlighten young neurosurgical residents for further independent training of their manual skills in the anatomic lab. The course followed a step-by-step training program starting with artificial models in a static 2D exoscopic view field with subsequent transition to cadaveric animal models and the use of dynamic four-hand techniques and endoscopy. Materials and methods Since 2015, two 2-day workshops and four 1-day workshops have been organized. All courses consisted of short theoretical and prevailing hands-on practical part and were designed mainly for manual skills training. For optimal practical training, each pair of trainees were engaged with a separate working place equipped with a video system, exoscope, drill, suction, and a set of microsurgical and endoscopic instruments. A total of 48 trainees, including residents of the Nikolay Nilovich (NN) Burdenko National Medical Research Center of Neurosurgery (NMRCN), the Russian Medical Academy of Continuous Postgraduate Education, and other institutions from different regions of Russia, completed the program. Analysis of evaluation sheets revealed that over 90% of trainees were under the age of 30. Results The key idea - accommodation to endoscopy through a series of microsurgical exercises in 2D visualization - has been successfully actualized and met with interest. After analyzing the questionnaires, we found that an overall satisfaction rate was high. The vast majority of trainees intended to gain further experience and apply new techniques in their clinical neurosurgical and microsurgical practice. The number of practiced techniques and the quality of the provided equipment were considered by the participants as good or very good. The highly individualized training course with a participant/tutor ratio of 4:1 and the use of tissue models (no sacrifice of living animals) was well appreciated. Conclusion The demand for a workshop indicates a lack of such training activities for young professionals, such as the one we presented herein. Evaluation of the courses by the trainees showed that the contents of workshops corresponded to their tasks and expectations, regardless of their previous experience. The workshop was not only the 'stepping stone' from which the path of practical self-development should begin but also initiated the development of a whole series of specially focused training workshops on microsurgery and endoscopy for neurosurgeons.

Keywords: endoscopy; microneurosurgery; microsurgery; neuroendoscopy; neurosurgery; practical training; surgical simulation.

Figure 1. Instrumentation used for training

A: exoscope and holding arm. B: instruments for microsurgical part (needle holder, forceps, scissors, retractor, hook dissector, microforceps, microneedle holder, microscissors). C: instruments used for endoscopic part (0- and 45-degree 4 mm rigid telescopes, straight and curved Blakesley forceps, suction cannula, curettes, dissector, electric drill).

Figure 2. Supervision of a couple of the trainees during endoscopic manipulations

Left: overall view of the working place. Right: bi-nostril positioning of the instruments (both trainees are involved in the manual exercise).

Figure 3. Results of the evaluations of the workshops by participants obtained after analysis of feedback forms