Diplomatosis

Microsurgery training course, Columbia University, New York

Authors: Nigel Abreo, Niroshan Sivathasan 

Publication date:  28 Oct 2009


Microsurgery is a technique used in a wide range of surgical specialties, including neurosurgery and cardiothoracic, plastic, orthopaedic hand, and, vascular surgery. The aim of any basic microsurgery course is to introduce the fundamental skills and techniques required for microsurgical dissection, anastomosis, and neurovascular repair.

Why did you do it?

Currently, only two microsurgery courses are run in the United Kingdom, each costing about £1300 (€1500; $2000) for five days. These courses are offered sporadically and infrequently during the year, have relatively high student to teacher ratios, and require animal licences to practise. Furthermore, they are often oversubscribed and have waiting lists. With most surgical departments strictly limiting the number of junior doctors allowed on leave at any given time, trainees often find themselves constrained and competing with colleagues to attend these seldom obtainable courses. Additionally, given that study allowances for trainees have been drastically slashed, the cost and value for money of any course are even more important.

On searching the internet, we found several courses around the world, including India, Romania, Singapore, and the United States. We chose to attend the Columbia University microsurgery course 2009 in New York City.

Each year the Columbia microsurgery course teaches roughly 80 people in numerous disciplines and from 13 countries. We felt that biweekly availability, a 3:1 student to teacher ratio, the high quality of equipment, and the prestige of an Ivy League university made this course the most alluring.

How is the course structured?

The microsurgery training course was an intensive five day (40 hour) course based on sedated albino rats and held in a dedicated training laboratory in the department of orthopaedic surgery at Columbia University Medical Center. The instructor of the microsurgery laboratory is a qualified veterinary surgeon who has taught the course for the past 12 years and who also spearheads multiple microsurgical research projects. The teaching approach was to demonstrate key techniques and then to foster our independent skill development, but with assistance and appraisal being available whenever needed. Teaching was supplemented with video lectures before each practical session.

Each day had specific objectives, goals, and practical tasks.

Day one

The first day started with three videos on the mental approach to microsurgery and an overview of the microscope and the handling of microsurgical instruments. These were followed by a practical session on forehand and backhand suturing on a glove under the microscope in various orientations, using 10-0 nylon suture material. Once we were comfortable, we watched another video demonstrating a two stay suture end to end arterial anastomosis technique. The practical session for the afternoon consisted of dissecting out femoral vessels and an end to end arterial anastomosis of a femoral artery of 1 mm diameter. This was our first experience of operating under the microscope and it proved to be gruelling both mentally and physically. We were rather disheartened, but the instructor advised us that the first day was the most difficult day and that struggling at that point was normal. She reassured us that our proficiency would improve as the course progressed.

Day two

Day two started with two videos on “one way up” arterial anastomosis and end to end venous anastomosis. The practical session that followed entailed completing as many anastomoses as possible in that day; each completed segment was assessed for patency and critiqued on quality of repair. Moreover, as each microscope was connected to a large screen monitor the instructor provided feedback and tips as we operated. By the end of the day we experienced what felt like an exponential leap in our abilities and our confidence blossomed with each successful anastamosis.

Day three

On day three we were forewarned to expect the technically most difficult task in the form of an interpositional vein graft using, in our task, the femoral artery and epigastric vein. This technique was challenging, but on successful completion after many intense hours it was very satisfying watching blood course through the patent graft.

Days four and five

Day four followed the now familiar routine of video then practical session, this time on end to side anastomosis of the femoral artery to the femoral vein and peripheral nerve (sciatic) repair. Varying levels of proficiency meant a variable amount of free time was left, during which we were encouraged to practise as much as we wanted—with no limits placed on rats or materials. At this stage we felt extremely comfortable operating under the microscope and handling tissue at a microscopic level. The fifth and final day comprised an open practice session followed by a skill evaluation, entailing completion of arterial and venous anastomoses within two hours. At the end of the course we were given a certificate and a manual on microvascular and microtubular surgery to complement the programme.

How much does it cost?

In addition to a favourable exchange rate, convenience of travel, and an exciting location, at $1600 (£970; €1000) the course was also financially competitive. One should allow around £650 for the return air fare and accommodation and at least £200 for routine expenses and travel in New York City, making the cost of the course comparable to one in the United Kingdom. Indeed, we made further savings by using the opportunity to purchase surgical loupes.

Was it worth it?

The high frequency of workshops with lack of animal licence bureaucracy facilitates flexibility and convenience in planning. The course was run in a structured but friendly manner in a relatively informal and unpressured working environment and with the opportunity to take breaks as needed, providing an optimal training atmosphere.

We highly recommend this course, not least because it combines a great holiday with scholarship, but to benefit you should be at a minimum level of senior house officer or specialty training year 2. If you are taking study leave to go on a course, why not combine it with the shopping, eating, and nightlife in New York City?

Further information

Yelena Akelina, associate director and instructor; Columbia University Medical Center, 622 W 168 Street, PH building, 11 floor, room 1158, New York, NY 10032, USA; email:  ya67@columbia.edu; website: [Link] .

Competing interests: None declared.

Nigel Abreo senior house officer in plastic surgery  St Thomas’ Hospital, London
Niroshan Sivathasan specialist registrar in plastic surgery  Queen Victoria Hospital, East Grinstead

Correspondence to: N Sivathasan  niroshan.s@virgin.net

Cite this as BMJ Careers ; doi: