Journal Logo


Microworld: A Novel Device for Training of Basic Microsurgical Skills in Different Vectors and Planes

Titov, Oleg M.D.; Salamov, Ibragim M.D.; Titov, Igor; Demidova, Maria M.D.; Bykanov, Andrey M.D., Ph.D.

Author Information
Plastic and Reconstructive Surgery: October 2021 - Volume 148 - Issue 4 - p 689e-690e
doi: 10.1097/PRS.0000000000008376

Microsurgery is similar to fencing: the surgeon “attacks” the target with stabbing, cutting, and blunt weapons (e.g., needle, scissors, forceps), masterfully maneuvering their tips and blades in different planes and directions. This art requires a long, step-by-step training, which usually starts from working on synthetic models.

Most of them include a polymer membrane (e.g., surgical glove) stretched over a rigid frame (e.g., cardboard, metal frame, box).1–5 However, these simulators have only one working plane, which limits the operator’s actions and reduces the educational potential of training.

Here we present the “Microworld”—a novel synthetic simulator with multivector and multiplanar relief, allowing one to train the crucial microsurgical actions in a challenging three-dimensional environment. The Microworld includes a corpus and a replaceable membrane. The corpus has a hemispheric shape (diameter 30 mm) and contains multiple grooves of constant width (1 mm) and depth (1.5 mm), located in meridional and parallel directions, like the lines of a geodetic grid (Fig. 1). The top comprises a compass pattern, which guides the operator’s movements. The base includes an additional groove, designed to fix the membrane (e.g., a piece of surgical glove) with a rubber band.

Fig. 1.
Fig. 1.:
(Left) Disassembled Microworld. The corpus includes 16 meridians, five parallels, and 80 areas of their intersection. The pattern on the top serves as a compass. Four grooves directed to the center indicate the primary vectors (north, south, west, and east). Groove entering the square is “northern.” The square corners indicate secondary vectors (northwest, northeast, southwest, and southeast). (Right) Assembled Microworld. Membrane is presented by a piece of vinyl glove, fixed by a hair tie (diameter 15 mm). The grooves are slightly but sufficiently visible through the glove.

The assembled Microworld is located at the operator’s workplace in such a way that the “northern” vector is directed forward. It can also be fixed to the table using double-sided tape. After that, the operator can use the membrane, stretched over the grooves, for training of different microsurgical skills (e.g., handling the microscope, cutting, puncture, suturing). For some possible exercises, see Figure, Supplemental Digital Content 1, which shows (above, left) point incisions of the membrane by the very tips of microscissors; (above, second from left) linear incisions; (above, second from right) arcuate incisions; (above, right) circular incisions; (below, left) puncture by atraumatic microneedle; (below, center) interrupted suturing of intact membrane; (below, right) interrupted and continuous suturing of previously cut membrane (“flower patch”),

The main rule of training is the constant deliberate adaptation to the directions and planes, embedded into the simulator workspace: the operator orbits the Microworld, not the opposite! The Microworld has the following advantages:

  1. Multivector and multiplanar relief simulates the tubular, globular and other complex surgical objects with hard-to-reach places (e.g., vessels, nerves, ducts, eyeballs).
  2. Spherical coordinate system, created by meridians and parallels, can be used for objective assessment of the performed tasks regarding their localization in the operative field (skill mapping).
  3. Compass-based system of landmarks allows giving and following clear instructions according to the principles of spatial navigation, which may improve the skill of communication within the operating team.
  4. The known width of grooves allows measurement of the optimal distances between the needle entry and exit points, the interstitch distances, the length of the knot tails, and other important dimensions.
  5. Replaceable membrane is universal, as it allows training of all basic microsurgical actions. Also, it is very inexpensive.
  6. Small and portable corpus significantly reduces the required membrane area and thus further decreases the cost.

Overall, the Microworld adds a third dimension to the membrane models and thus increases the complexity and realism of exercises, expanding the repertoire of the surgeon’s skills. It may be helpful for neurosurgeons, plastic surgeons, ophthalmic surgeons, and others.


Oleg Titov is the inventor of Microworld. It is described and claimed in the patent on invention no. RU 2739207 С2, priority date August 13, 2020. The other authors have no financial interests to disclose. No funding was received for this article.


1. Belykh E, Martirosyan N, Kalani Yashar M, Nakaji PMicrosurgical Basics and Bypass Techniques. 2020New YorkThieme
2. Acland RDPractice Manual for Microvascular Surgery. 1989St. LouisMosby
3. Guler MM, Rao GSCanniesburn “ever-ready” model to practise microsurgery. Br J Plast Surg. 1990;43:381–382
4. Crosby NL, Clapson JB, Buncke HJ, Newlin LAdvanced non-animal microsurgical exercises. Microsurgery. 1995;16:655–658
5. Lahiri A, Lim AY, Qifen Z, Lim BHMicrosurgical skills training: A new concept for simulation of vessel-wall suturing. Microsurgery. 2005;25:21–24


Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:

  • Text—maximum of 500 words (not including references)
  • References—maximum of five
  • Authors—no more than five
  • Figures/Tables—no more than two figures and/or one table

Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS’ enkwell, at We strongly encourage authors to submit figures in color.

We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

Supplemental Digital Content

Copyright © 2021 by the American Society of Plastic Surgeons