Validating a Scalable Approach to Microsurgery Education in Resource-Limited Countries

Abstract

Background

Microsurgery remains largely nonexistent in sub-Saharan Africa due to a lack of access to specialized training and microsurgical instruments. However, smartphones with magnification capabilities are globally widespread, even in low-resource nations. The use of smartphones as simulators for microsurgery training has been previously reported, but little is known with respect to skills acquisition over time.

Methods

A cohort of Ethiopian plastic surgery attendees and residents participated in a microsurgery training workshop. Before and after the workshop, as well as 6 months afterward, participants were recorded performing a synthetic vessel repair using a smartphone for magnification. Video recordings were graded by four microsurgeons using the Stanford Microsurgery and Resident Training (SMaRT) scale, a validated instrument for assessing microsurgical skills.

Results

A total of 13 participants were surveyed and recorded. Overall microsurgical performance SMaRT scores significantly improved (2.05 vs. 2.72 on a five-point scale; p = 0.001) upon completion of the workshop, and continued to increase (3.05), but not significantly so (p = 0.201) 6 months afterward. However, improvements were maintained at 6 months. Significant improvement was noted in all SMaRT scale domains postworkshop and further significant improvement in instrument handling was noted at 6 months.

Conclusion

Our findings suggest that smartphones can serve as valuable tools for microsurgery training in low-resource settings. Further research is warranted to evaluate the long-term impact of smartphone-based simulation training on skill acquisition and clinical outcomes in low-resource settings, but even in the short-term participants were able to demonstrate significant improvement, as well as maintenance to improvement of skill at 6 months follow-up.

Keywords

global surgery - microsurgery education - education

Publication History

Received: 23 November 2024

Accepted: 12 May 2025

Accepted Manuscript online:
21 May 2025

Article published online:
03 June 2025

• References

• 1 Suh JD, Sercarz JA, Abemayor E. et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2004; 130 (08) 962-966
• 2 Kakarala K, Emerick KS, Lin DT, Rocco JW, Deschler DG. Free flap reconstruction in 1999 and 2009: changing case characteristics and outcomes. Laryngoscope 2012; 122 (10) 2160-2163
• 3 Liu JCJ, Ellis DA. Editorial: eating in the age of smartphones: the good, the bad, and the neutral. Front Psychol 2021; 12: 796899
• 4 Kim DM, Kang JW, Kim JK, Youn I, Park JW. Microsurgery training using a smartphone. Microsurgery 2015; 35 (06) 500-501
• 5 Jianmongkol S, Vinitpairot C, Thitiworakarn N, Wattanakamolchai S. A comparison of using a smartphone versus a surgical microscope for microsurgical anastomosis in a non-living model. Arch Plast Surg 2022; 49 (01) 121-126
• 6 Leśniewski K, Czernikiewicz K, Żyluk A. An assessment of usefulness of smartphone as a magnifying device for microsurgery training. Ortop Traumatol Rehabil 2019; 21 (06) 457-466
• 7 Rahman SA, Henderson PW. Calibration tool to standardize magnification during smartphone-based microsurgical skills training. Plast Reconstr Surg Glob Open 2020; 8 (06) e2918
• 8 Huotarinen A, Niemelä M, Jahromi BR. Easy, efficient, and mobile way to train microsurgical skills during busy life of neurosurgical residency in resource-challenged environment. World Neurosurg 2017; 107: 358-361
• 9 Capkin S, Cavit A, Kaleli T. Microsurgery training with smartphone. Handchir Mikrochir Plast Chir 2018; 50 (06) 443-445
• 10 Pafitanis G, Hadjiandreou M, Miller R. et al. The use of mobile computing devices in microsurgery. Arch Plast Surg 2019; 46 (02) 102-107
• 11 de Berker HT, Čebron U, Bradley D. et al. Protocol for a systematic review of outcomes from microsurgical free-tissue transfer performed on short-term collaborative surgical trips in low-income and middle-income countries. Syst Rev 2021; 10 (01) 245
• 12 Inchauste SM, Deptula PL, Zelones JT, Nazerali RS, Nguyen DH, Lee GK. Global health microsurgery training with cell phones. Ann Plast Surg 2020; 84 (5S, suppl 4) S273-S277
• 13 Satterwhite T, Son J, Carey J. et al. The Stanford microsurgery and resident training (SMaRT) scale: validation of an on-line global rating scale for technical assessment. Ann Plast Surg 2014; 72 (Suppl. 01) S84-S88
• 14 Cai L, Meyers N, Chang J. Modeling the lifetime impact of reconstructive plastic surgery training: implications for building capacity in global surgery. Plast Reconstr Surg Glob Open 2024; 12 (02) e5577