Randomized Controlled Trial: Acquisition of Basic Microsurgical Skills Through Smartphone Training Model

Abstract

Background: Microsurgery is essential in various surgical specialties, but learning these skills is challenging due to work hour limitations, patient safety concerns, documentation time, and ethical objections to practicing on live animals. This randomized controlled trial compares 2 microsurgical training models: the smartphone model and the microscope model.

Methods: Thirty students without prior microsurgery experience were randomized into 3 groups: control (CG), smartphone (SG), and microscope (MG). Participants performed microsurgical skill tests and a chicken femoral artery anastomosis before and after 10 hours of standardized training according to their assigned models. The CG performed the test twice without training. Performance was assessed by time to complete the anastomosis, University of Western Ontario Microsurgery Skills Assessment scale, anastomosis patency, and time to complete the round-the-clock test.

Results: No significant differences were observed among groups at baseline. Significant improvement in anastomosis time was achieved in the MG (27.4 minutes, P = 0.005) and SG (27.0 minutes, P = 0.005), but not in the CG (13.1 minutes, P = 0.161). On the University of Western Ontario scale, the MG improved by 6.0 points (P = 0.002), the SG by 5.1 points (P = 0.006), and the CG by 2.4 points (P = 0.009). Patency rate significantly improved in the MG and SG (P = 0.002) but not the CG (P = 0.264). Round-the-clock time improved in all groups (P < 0.001).

Conclusions: Basic microsurgical skills can be effectively learned using the smartphone training model, with performance improvements comparable to the microscope model. Its main limitation is the lack of stereoscopy.

Fig. 1.

Schematic overview of our study protocol.

Fig. 2.

Testing for anastomosis patency with a clear obstruction (A) and a patent vessel (B).

Fig. 3.

Student practicing on the smartphone model.

Fig. 4.

Student practicing on the microscope model.

Fig. 5.

Box plots of the time to complete the round-the-clock test pre- and posttraining (minimum, first quartile, median, third quartile, and maximum).

Fig. 6.

Box plots of the time to complete the anastomosis pre- and posttraining (minimum, first quartile, median, third quartile, and maximum).

Fig. 7.

Box plots of UWOMSA score pre- and posttraining (minimum, first quartile, median, third quartile, and maximum).