Abstract

Background: The STA-MCA bypass is a technically challenging procedure that many resident neurosurgeons fail to garner experience with during training. Our 3D-printed micro-vessel task trainer is designed to create a user friendly, portable, multi-vessel compatible suturing training protocol for neurosurgical residents.

Objective: Goals are 1) determine the capacity of the device to discriminate skill level of residents and 2) use objective measures to analyze improvements in performance across trials to provide evidence for task trainer efficacy.

Method: Neurosurgical resident suturing trials using bio-synthetic vessels and trainers are scheduled, performed and recorded in OR with Zeiss microscope. Anastomosis leakage is measured, and videos are analyzed with blinded Northwestern Modified Objective Assessment Tool (NOMAT).

Result: In 2019, approximately 20 hours of 2mm vessel anastomoses sessions with 9-0 and 10-0 sutures used among 7 neurosurgical residents with various experiences are analyzed and recorded. Each resident averaged 4.7 anastomoses sessions: range 2-7. We used a paired t-tests to compare individual performance changes, and Kruskal-Wallis test to compare PGY group (PGY1-2, 3-4, 5-6) performance. The two-tailed p-values were calculated using SAS. Final NOMAT scores were statistically higher than baseline by 19.7 points (p=0.035, sd=19.2). An inverse relationship exists between NOMAT improvement and PGY level, as well as absolute time reduction from final trial to baseline. A negative correlation exists between number of trials and time to completion (Spearman correlation coefficient=-0.93, p=0.0026).

Conclusion: Unique task trainer-based simulation in learning micro-anastomoses suturing is advantageous and can be incorporated into resident’s curriculum. Video analysis of trials documents performance, progression and improvement of performance.