Today, microsurgery is more a surgical technique than a specialty. Its contribution in reconstructive surgery (bones, soft tissues, vessels, nerves) is fundamental. It will soon be integrated into the training of all surgeons who will have to acquire the dexterity and the patience that working with a microscope demands. Invivox went to meet Dr Yelena Akelina, a passionate training instructor in practice since 1996.
INVIVOX : What is microsurgery?
Microsurgery is conducted with the assistance of a surgical microscope. Everything is done with the help of magnification using micro-instruments or micro-sutures starting from 8.0 to 11.0, thus “microsurgery”. In microsurgery, surgeons use a microscope instead of a magnifying lens. This allows surgeons and assistants to perform surgical techniques with 4-40 times magnification. This allows the visualization of small structures, such as arteries, veins, nerves and lymphatics vessels. The visualization of such structures allows surgeons to reattach amputated body parts (replantation), to transplant tissue from one part of the body to another (microvascular transplantation), to repair nerves and blood vessels, etc.
INVIVOX: How does microsurgery fit in with other specialities?
Microsurgery is used most in plastic, reconstructive, hand, maxillofacial and neck surgery, but also in ophthalmology and others. The IMSS (International Microsurgery Simulation Society) was established by a group of microsurgery educators with the main goal being to promote excellence in microsurgery education and training worldwide. In reality, microsurgery is very useful for any surgeon. There are probably around 2000 of us in the world who are currently practicing microsurgery.
« When you learn microsurgery, you become a better surgeon. Wherever and whenever I say that, everyone agrees »
INVIVOX : What training do you offer?
Our training is unique. It’s a one-on-one individualized training with only 3 surgeons per session every week of the year except during holidays. We are working on animal models looking at arterial anastomosis for example, and practicing different techniques. We record videos to improve our practice and analyze mistakes. Some of those videos can be found on www.invivox.com. This course is very popular because the trainees receive a lot of feedback on their work.
INVIVOX : Who could come to your training?
We don’t have any requirements, no special skills are needed to participate to this training. Some young students without any medical education could still learn to use the microscope.
Good eyes and good hands certainly help!
INVIVOX : Why is it important to learn in the lab? What makes your training different?
Everybody teaches the same things in every microsurgery course in the world, but the difference with us is that we are really hands-on and individually tailored. During the course, students receive a list of tasks they have to pass to be granted the certificate of completion. If they don’t succeed they need to take the class again. It’s important because here you are learning on animals. Otherwise, if people didn’t learn on animals, they would have to practice directly on people which of course carries a certain risk.
INVIVOX : What are the main benefits of this training? What are the key points attendees can expect to acquire?
The main point is the ability to work under a microscope with magnification. The second point is to coordinate your eyes, hands and feet. Third, they should be able to successfully complete arterial venous anastomosis and nerves sutures. They will be able to do a vein graft with a much reduced operation time. We will often expect our students to complete an arterial anastomosis on Friday within 30 to 40 minutes, compared to the 2.5 hours taken on Monday.
INVIVOX : How is Invivox helping you?
Invivox is very important for us because it’s modern and very easy to use the platform. We can post our course’s information, pictures, articles etc. People can directly ask questions that Invivox will answer for me. Invivox takes care of registrations, payments and travel planning. Before I had to do it all by myself and now Invivox is doing it for me. They also have a database helping us with social networks and they even have a magazine!
“I always wanted to improve the visibility of microsurgery online but I never felt that I was doing enough, Invivox really helped us.”
INVIVOX : Why is practical training important in your speciality? What does the future hold?
We are looking towards super microsurgery. Our work ultimately depends on clinical needs. Surgeons have developed new techniques so they need new training. We start with 1 mm vessels, super microsurgery is 0.3 mm. It’s a big difference. The next step would be to incorporate that in our courses. I would like topics on robotic microsurgery. We are developing new machines and robotic surgery can completely eliminate trauma so the quality of surgery improves significantly.
* Yelena Akelina, DVM, MS is a Research Scientist and a Director/Instructor in Clinical Microsurgery at the Microsurgery Research and Training lab at the Department of Orthopaedic Surgery, Columbia University (New York).