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.
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”), https://links.lww.com/PRS/E625.
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:
- Multivector and multiplanar relief simulates the tubular, globular and other complex surgical objects with hard-to-reach places (e.g., vessels, nerves, ducts, eyeballs).
- 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).
- 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.
- 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.
- Replaceable membrane is universal, as it allows training of all basic microsurgical actions. Also, it is very inexpensive.
- 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
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