Elsevier

World Neurosurgery

Volume 107, November 2017, Pages 263-267
World Neurosurgery

Doing More with Less
A Portable Training Model for Deep Bypass Surgery

https://doi.org/10.1016/j.wneu.2017.07.153Get rights and content

Introduction

Deep bypass surgery remains a challenging operative procedure. For novice trainees, there is a high barrier to improving the microsurgical skills needed for this procedure because of the relatively low number of cases and the high cost of microsurgical instruments. Here, the authors introduce a training model that includes highly accessible devices and does not require a microscope.

Materials and Methods

The surgical environment consisted of two 15.5-cm straight serrated forceps with a 1-mm tip width (Medicon, Tuttlingen, Germany), 9-cm curved iris scissors (Medicon), 4-0 black silk suture, gauze, and a 15 × 10.5 × 3.5-cm-sized box with a transparent cover. These materials are affordable even in low-income countries.

Procedure

To understand and learn the hand positioning used in the deep surgical field, suturing practice was performed as follows: the forceps and a needle were placed in a slanted position, with hand position maintained at a 50° angle between the 2 forceps. This was also performed above the desk, without wrist support.

Conclusions

Our training system will be helpful, especially for deep bypass surgery, since training with similar muscle effort and fatigue can improve surgical skills. This system is economic, highly accessible, and available even for portable training.

Introduction

Deep bypass surgery, an alternative treatment for complex aneurysms and skull base tumors, remains a challenging operative procedure.1, 2 Because of the relatively few number of cases, it is not easy for young neurosurgeons to acquire sufficient practical experience. Although there have been several studies on various training programs for deep bypass surgery,3, 4 novice trainees still face difficulties in training because of the high cost of advanced instruments and the awkward hand posture required due to the deep and narrow surgical field. The aim of this paper was to introduce a basic training model to teach the hand posture suitable for deep bypass surgery using affordable and simple devices.

Section snippets

Portable Training System

The current training model was invented to improve deep bypass skills without the need for a microscope. The surgical environment consisted of two 15.5-cm straight serrated forceps with a 1-mm tip width (Medicon, Tuttlingen, Germany), 9-cm curved iris scissors (Medicon), 4-0 black silk suture, gauze, and a 15 × 10.5 × 3.5-cm-sized box with a transparent cover (Figure 1A and B) The box is a lunchbox that can be obtained easily from a retail store and costs approximately 3 USD per unit. A box

Discussion

Technical skills training in neurosurgery mostly are achieved in the operating room. However, because cases that require deep bypass are quite rare, it is challenging for less experienced neurosurgeons to learn the unique technique.5 Few publications have addressed a training model especially for deep bypass surgery.

A variety of materials, such as rat, chicken wings, artificial vessels, and placenta, have been used for microvascular training.3, 4, 6, 7 Some studies introduced training models to

Cited by (4)

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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