Relaxation and Performance During Microsurgical Learning

Introduction: Microsurgical learning is a difficult and stressful process, requiring self-control to achieve relaxation. The purpose of this study is to evaluate peripheral and central nervous system relaxation during microsurgical training. Methods: This cohort study included ten medical students with no previous experience in microsurgery. The somatic peripheral nervous system was evaluated by the force applied to a custom-designed microsurgical needle holder. The autonomic peripheral nervous system was assessed by a heart rate monitor. Central nervous system relaxation was evaluated by the State and Trait Anxiety Inventory scores. The quality of the anastomosis was graded by the Microsurgical Anastomosis Rating Scale (MARS10). These data were compared to a group of 5 senior microsurgeons who underwent a single assessment. Results: The time to complete the anastomosis and the force decreased significantly with training after only 2 weeks (P < .05). After 4 weeks of training, no statistical difference was observed between students and experts regarding force while the time of suture was still significantly different at 30 days (P = .001). The maximum heart rate decreased significantly at 2 weeks (P = .01). Anxiety scores decreased significantly between days 1 and 15 (P = .002 and P = .036). The MARS10 score demonstrates that the quality of the suture increases significantly during the first 15 days (P = .006). Conclusion: Peripheral and central nervous system relaxation as well as the quality of the microsurgical anastomosis increase significantly after only 15 days of learning. The force-sensing microsurgical needle holder offers a new tool for the evaluation of relaxation and can function as a learning aid.