Tesis

Penilaian Keterampilan Bedah Mikro Menggunakan Modifikasi Pompa Aliran Pulsatil Menggunakan Model Paha Ayam

Pendahuluan. Sebelum berhadapan dengan pasien yang nyata, seorang ahli
bedah plastik pemula berupaya meningkatkan ketrampilan dengan berlatih pada
model . Penelitian ini mengimplementasikan metode pelatihan berbasis wet-lab
menggunakan perfusi ke a.femoralis ayam untuk mengevaluasi peningkatan
keterampilan mikro.
Metode. Dua puluh satu residen bedah plastik (wanita n = 14 (66,7%) dan laki-laki n = 7(33%))tanpa pengalaman mikro sebelumnya
direkrut dalam penelitian ini. Menjalani serangkaian pelatihan,yang terdiri dari satu sesi kognitif dan lima sesi berbasis keterampilan melakukan anastomosis término-terminal arteri femoralis ayam dengan diameter 2 mm. Pre dan post test dinilai menggunakan
University of Western Ontario Microsurgical Assessment (UWOMSA). Sesi keterampilan yang direkam pada video, dan dinilai oleh konsultan mikro
sebagai evaluator tunggal. Penelitian ini terbatas untuk arteri end-to-end anastomosis.
Hasil. Dari total 42 video termasuk 21 modul simpul-mengikat dan 21 modul
anastomosis. Median pre-test skor UWOMSA adalah 23 tapi tidak ada subjek
yang berhasil mencapai skor maksimal 30. Skor median post-test adalah 27,5
(hampir 5 poin perbaikan, P = 0,0) dan 2 subyek mencapai skor 30. Nilai ratarata
waktu yang dihabiskan untuk menyelesaikan prosedur anastomosis juga
lebih cepat dari 41,86 menjadi 34,14 menit (P = 0,01).
Kesimpulan. Menerapkan pelatihan yang diusulkan akan meningkatkan
keterampilan pemasangan anastomosis.


Background. Before entering real clinical setting, a novice plastic surgeon will
benefit from repetitive training on non-living models. This study implements the
bench-top training method using perfused chicken thigh model to evaluate
improvement in microsurgical skills.
Methods. Twenty-one plastic surgery residents (women n=14 (66.7%) and men
n=7 (33%)) with no prior microsurgical experience were recruited in this study.
They underwent a set of training, consisting of one cognitive session and five
skill-based sessions performing the end-to-end anastomosis using chicken
femoral artery with a diameter of 2 mm. They were assessed using the University
of Western Ontario Microsurgical Skills Assessment (UWOMSA) scoring
system at the first skill session and re-evaluated at the fifth skill session. The skill
sessions are recorded on video, blinded, and assessed by a consultant
microsurgery as a single evaluator. The study was limited to arterial end-to-end
anastomosis.
Results. Forty-two videos were reviewed, including 21 knot-tying sessions and
21 anastomoses. The median pre-test UWOMSA score was 23 but none of the
subjects managed to reach the maximal score of 30. The median post-test results
were 27.5 (almost 5 points improvement, P=0.0) and 2 subjects achieved a score
of 30. The average time spent to accomplish the full anastomosis procedure was
also reduced from 41.86 to 34.14 minutes (P=0.01).
Conclusion. Using the proposed training skill-based session will improve the
subject’s microvascular anastomosis skill.