Microsurgery at Home during COVID-19 Pandemic: A Do-It-Yourself Toolkit

The coronavirus disease 2019 (COVID-19) pandemic changed the face of surgical education globally, and posed unique challenges stemming from isolation measures. Residents have been redeployed to the frontline to combat the pandemic, and provided much needed aid. However, the experience gained was often outside the scope of expected resident training. While understandable, the decrease in elective microsurgical cases has limited resident exposure to training opportunities, including lengthy and complex microsurgical reconstructions. Often, the case category minimum numbers are not being met by residents, raising questions regarding surgical competencies.[1]

In the face of these unprecedented circumstances, many residency programs reallocated staffing levels to ensure safety, while also protecting time for resident education, virtual didactic teaching, clinical exposure, and research.[2] The lifting of Health Insurance Portability and Accountability Act (HIPAA) restrictions allowed residents to attend and conduct consultations with patients, and watch live-streaming operations by means of telemedicine/teleconference.

In other programs, residents are able to perform anatomic cadaveric dissections in the laboratory and practice microsurgical skills at home with portable individual microscopes.[3] Plant-based and deceased animal models are readily available for do-it-yourself (DIY) microsurgery practice at home (i.e., chicken thigh).[4]

As such, we present a DIY toolkit, which allows for microvascular anastomosis without the use of a microscope. The authors use 6.0X prismatic loupe magnification with an integrated headlight that provides sufficient magnification for microvascular anastomosis. The use of loupes is closer to real-life situations, compared with the usage of iPads or smartphones to simulate a microscope. Dissection of the chicken femoral vessels and nerve is performed without magnification. The setup of a home-based microsurgical training model is simple and practical. It consists of seven elements: (1) jeweler's forceps, (2) gauze, (3) cotton swab (Q-tip), (4) clamp, (5) a 10–0 suture, (6) scissors, (7) needle holder, and (8) a 10 mL syringe with water for irrigation ([Fig. 1]).

Fig. 1 The setup of the do-it-yourself home-based microsurgical model includes 1. jeweler's forceps, 2. gauze, 3. cotton swab (Q-tip), 4. clamp, 5. a 10–0 suture, 6. scissors, 7. needle holder, and 8. a 10 mL syringe with water for irrigation. The bottom left image shows a magnified view of the clamps and the ex-vivo femoral vessel divided and ready for anastomosis.

This model offers advantages of ease of setup, adjustable to fit at home desk surfaces, and high-fidelity real tissues for practice at a relatively low cost depending on the supplier. The residents watch online training videos on how to perform the anastomosis, and learn independently at their own pace. Upon completion of the anastomosis, the lumen is divided longitudinally, and the anastomotic lapse index (ALI) score calculated ([Fig. 2]). Patience, perseverance, and resilience should be practiced as self-directed learning is difficult, and progress may be more gradual as compared with having a designated expert instructor.[5] The ALI score is a validated tool to estimate the competency level of the trainee.

Fig. 2 Once the anastomosis is complete, the lumen of the vessel is divided longitudinally to assess the internal surface and the quality of the suture placement. The anastomotic lapse index score is then calculated based on the number of errors and the frequency of occurring.

Publication History

Received: 07 January 2021

Accepted: 15 February 2021

Article published online:
14 April 2021

• References

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