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"Level Up": A Simple, Novel Technique for Resident Arterial Anastomosis Training
Kelly Spiller, MD
Douglas Dembinski, MD
Nathan Lawera, MD
Victoria Lee, BS
University of Cincinnati Medical Center
2025-01-10
Presenter: Kelly Spiller, MD
Affidavit:
I certify that the submitted material represents original work of the above-named medical student, residents, and attending physician. This work has not yet been published in any scientific journal and has not yet been presented at any major meetings.
Director Name: Ann Schwentker, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
As the field of microsurgery expands, it is imperative to develop a simple, low-cost training model to promote resident competence with microsurgical skills. Although several models are described, these are limited by financial, material, and time constraints. There is also notable variation in access to training opportunities across residency programs. Therefore, the goal of our study was to develop and implement a simple, reproducible, and low-cost training model for the completion of in-vivo arterial anastomoses.
Our model emphasizes progressive resident autonomy by using three discrete technical "levels." Level 1, for novice trainees, employs the use of double approximators. A supervising surgeon places opposing sutures at 0 and 180 degrees, assists the novice by catching the needle after each bite, and aids in reloading the needle.
After mastery of needle control is demonstrated in level 1, the trainee progresses to level 2 where they place "180" sutures, catch, and reload their own needle. Double approximators are again employed. Finally, trainees graduate to level 3 in which the anastomosis is completed back to front without the use of double approximators. Time to complete in-vivo arterial anastomoses was measured pre- and post- education.
Post-implementation of our model, trainees have shown greater efficiency, completing in-vivo arterial anastomoses in less than 20 minutes, on average (n=9). These results show a promising cost-free model that can be easily implemented to advance microsurgical education nationwide.
