Validation of Tabletop Microscopes for Microsurgery Simulation and Training

Abstract

Purpose: Oral and maxillofacial surgery residency programs are increasingly adopting microsurgery as a core element of training; however, many barriers exist that limit trainees' proficiency. The purpose of this study was to perform a validation of 2 tabletop microscope simulations for their use as a training tool, which could serve as an affordable, alternative method to traditional microsurgery training methods.

Methods: A prospective, single-institution, multidepartmental validation study was performed. Two microscopes (monocular digital [DM] and binocular stereo [SM]) were used to perform anastomoses on simulation vessels including a silastic tube and a chicken thigh femoral artery. A microsurgeon panel was selected from a population of microsurgery faculty and fellows at Michigan Medicine (Ann Arbor, MI) to perform the anastomoses. The surgeons each performed 4 anastomoses, using each microscope with each vessel, and subsequently completed a survey evaluating the simulation. Predictor variables were the microscope and the vessel. Primary outcome variable was readiness for use, which was defined as the simulation's ability to incorporate into a microsurgical training curriculum in its current state. Secondary outcome variables included realism, value, usefulness, relevance, difficulty, and cost. Paired t tests were used to compare responses. Alpha was set to 0.05.

Results: Seven microsurgeons performed the simulation from the departments of oral and maxillofacial surgery (n = 5), plastic and reconstructive surgery (n = 1), and otolaryngology (n = 1). For readiness, the SM simulation required either no modification (n = 4) prior to implementation into a microsurgery curriculum or minimal modification (n = 3), compared to the DM simulation which required significant modification (n = 4) or extensive modification and re-evaluation (n = 3) (P = .002). The SM demonstrated a greater mean realism score than the DM for depth perception (5.00 vs 1.57, P < .001), field of view (4.57 vs 3.57, P = .038), lighting (5.00 vs 4.00, P = .038), and clarity (5.00 vs 3.86, P = .030). There was no statistically significant difference between SM and DM in value, usefulness, relevance, difficulty, or cost.

Conclusions: Tabletop microscopes demonstrate considerable promise in the future of microsurgical education. The SM simulation was a realistic simulation that may be ready for use in a microsurgical curriculum. Future studies are required to demonstrate the efficacy of this simulation on microsurgical trainees.