Background: Microsurgery is a branch of surgery that requires an operating microscope to perform meticulous procedures. Learning microsurgical gesture is difficult as muscular and nervous relaxation requires specific abilities. The quality of the microsurgical gestures measured by the level of relaxation of nervous and muscular system has not yet been explored.
In order to develop a robust tool to evaluate microsurgical gestures and to acquire the dexterity and
the required skills essentials for microsurgery, the “microsurgery-connected clamp” enabling
prehension force measurement was created in 2018 at the HEIG-VD by Antoine Nogueira during his
bachelor’s thesis under the supervision of Professor Didier Maillefer. The first tests were conducted as
part of a pilot study performed by Justine Lattion’s for her master’s thesis (data not published).
Significant differences could be highlighted between experts, intermediates and novices concerning
prehension force during a microsurgical procedure.
Objective: In this pilot study, we intend to take Lattion’s work on step further by demonstrating that
psychic, autonomic & somatic nervous system relaxation during a microsurgical gesture increases with
experience. This has never been explored to date.
Method: Ten medical students with no previous experience in microsurgery are included as subject.
Participants attended a four-weeks practical course to learn how to perform microsurgical knots on a
vessel. Briefly, this course included two one-hour sessions per week consisting of microsurgery training
under the microscope on a chicken wing containing easily dissectible arteries. Student’s progress was
assessed at three different times during the four weeks period (i.e. on day 1, 15 and 30) by monitoring
time and force applied on the connected needle holder, STAI scale and MARS 10 scale. Statistical
analysis was performed using Wilcoxon and Mann-Whitney tests and Spearman correlation.
Results: Both maximal and mean force applied when using the needle holder significantly decreased
with training (p<0,05). The time to perform a microsurgical knot diminished between the first day
While the force applied on the clamp and time to perform a microsurgical knot clearly lessened with training, we found an inversely significant proportional correlation in term of knot quality (p<0,05 R=0,9498). Moreover, our results showed that the anxiety followed the exact same trend as the force and time parameter with a greater reduction observed in
the first 15 days.
Conclusion: We confirmed that the connected needle holder allows for an objective assessment of subject’s capacity in microsurgery and demonstrated a somatic and psychic nervous system relaxation over time by practicing microsurgery.