Yorkshire microsurgery workshop

Authors: Laurence Glancz

Publication date: 26 Oct 2012

The Yorkshire microsurgery workshop is an affordable, hands-on introduction to the principles of performing microsurgery, held in the skills laboratory at Pinderfields General Hospital in Wakefield.

Who is it for?

This course is aimed at core surgical and plastic surgery trainees with little or no previous experience in microsurgery, but it could also serve as a refresher course for more senior trainees in plastic or hand surgery. The 11 delegates on my course comprised a fairly even spread of year 1 core trainees (CT1s) to year 4 specialty trainees (ST4s), with an ST7 the most senior participant.

When did you do it?

I did this course as a CT1 before starting my six month CT2 rotation in plastic surgery, to give me the basic microsurgical skills and knowledge. The aim was to get hands-on experience in a safe and well supervised environment.

This was the first time that the course had been run, although the same convenors have held the successful MY plastic surgery course on several occasions.[1] These courses, along with the other courses run by the conveners, are all accredited by the British Association of Plastic Reconstructive and Aesthetic Surgeons.

What was involved?

The two day course began with three 10 minute lectures covering the history of microsurgery and how to use the microscope and instruments. This was followed by 45 minutes of practice in microsuturing.

The rest of the course comprised further concise 10 minute lectures, each followed by practical sessions of one to two hours putting the topics into practice. Day 1 covered suturing, nerve coaptation, and arterial and venous end to end anastomosis, with 60 minutes at the end of the day for one’s own practice.

The difficulty level was raised on day 2, with end to side arterial anastomosis, in situ arterial and venous anastomoses, in situ interpositional vein graft anastomosis, and a final 90 minute session for one’s own practice, during which we were allowed to perform any of the aforementioned techniques or even attempt a free flap anastomosis.

High quality Carl Zeiss microscopes were provided for all participants. There was some variability in style, with two massive theatre microscopes also available. Delegates were encouraged to rotate and thus had the opportunity to become familiar with the different models available. All the anastomoses were performed on chicken vessels; the in situ work was done on chicken legs. As the chickens were dead, we were able to test our anastomoses by connecting a pressurised saline drip. According to the faculty, the chicken vessels had a similar feel to working with small calibre human vessels, which made the practical sessions more realistic.

A high faculty to delegate ratio (1:1 for most of the course) meant that there was always someone senior on hand to help when needed. The faculty comprised Yorkshire based plastics consultants as well as a few senior fellows and registrars. The trainers tended to look down the second eyepiece to watch us perform, providing helpful hints and tricks to improve technique.

The learning curve was steep, but plenty of time was allowed to put the techniques into practice. The differences in previous experience between delegates was therefore not an issue, as the most inexperienced still had time to complete most of the practicals.

Was there an exam?

This course had no exam. However, the faculty observed the candidates throughout the course to provide constructive criticism. Four prizes were awarded for “best CT and ST anastomosis” and the “most improved CT and ST”; each winner received a certificate and a set of microsurgical instruments. All course delegates received a certificate to show completion of the course.

How much did it cost?

The course fee was £450. This included tuition, breakfast, lunch, tea and coffee, and afternoon cakes and scones, as well as a dinner at an Indian restaurant in Wakefield. The fees included the cost of hospital parking and a DVD detailing the techniques taught during the course. As such, the course was extremely good value for money. Any profits made go towards purchasing kit for future courses or to fund charitable activities; the consultants give their services for free.

Was it worth it?

Definitely. As a complete novice, I benefited from the excellent grounding in the basic principles of microsurgery with important practical time and an impressive faculty to delegate ratio.

The course conveners emphasised that this course is not an alternative to the well established five day microsurgical courses available, such as those in Northwick Park, Canniesburn, and Frankfurt. These courses are longer and use live rat models but come at a price between £1300 and £1500. At £450, the Yorkshire microsurgery workshop is considerably lighter on the wallet.

Top tips

If you have to travel a long distance, it is probably worth booking accommodation nearby. I found that driving three hours a day was tiring and also meant that I missed out on the course dinner.

No pre-course reading or preparation is required. Delegates need simply to turn up with a willingness to learn and a steady hand; alcohol or caffeine consumption before the course are therefore inadvisable.