Evolution of an evidence-based supermicrosurgery simulation training curriculum: A systematic review

Area of Science:

• Surgical Simulation
• Medical Education Technology

Background:

• Supermicrosurgery (SM) involves delicate operations on 0.3-0.8 mm vessels, demanding advanced skills beyond conventional microsurgery.
• Current training programs often inadequately prepare junior surgeons for the complexities of SM procedures.
• Existing simulation models for SM lack comprehensive validation regarding their purpose and benefit.

Purpose of the Study:

• To systematically review and summarize existing supermicrosurgery simulation models.
• To assess the likely impact of these models on microsurgery training for small-caliber vessel procedures.
• To establish the clinical relevance and need for validation of SM simulation models.

Main Methods:

• A systematic literature search was performed following PRISMA guidelines, identifying articles from MEDLINE and other databases.
• Twenty-five studies were critically analyzed by two independent reviewers against predefined inclusion criteria.
• Included studies were analyzed for model classification (biological/non-biological, ex vivo/in vivo) and clinical correlation.

Main Results:

• Thirty-six articles were reviewed, identifying 15 distinct supermicrosurgery simulation models.
• No reviewed models demonstrated formal validity, though clinical correlations and specific skills were identified.
• A novel ladder-based curriculum was proposed, informed by expert questionnaires on model impact.

Conclusions:

• This review highlights the clinical relevance of SM simulation models and underscores the necessity for their validation.
• Existing SM training models facilitate the acquisition of specific surgical skills.
• A proposed curriculum integrates selected SM simulation models based on recognized clinical impact.