Synthetic Replica for Training in Microsurgical Anastomosis: An Important Frontier in Neurosurgical Education

  • Rudy J. Rahme
  • Chandan Krishna
  • Mithun G. Sattur
  • Rami James N. Aoun
  • Matthew E. Welz
  • Aman Gupta
  • Bernard R. Bendok
Part of the Comprehensive Healthcare Simulation book series (CHS)


Medical education has evolved through the years, moving away from the Halstedian apprenticeship model. The medical governing bodies involved in medical graduate education have established a set of rulings and recommendations focused on improving patient safety and curbing resident fatigue including limiting work hours to 80 h a week. In addition to duty hour regulations, decreasing volumes and dilution of surgical cases among an increasing number of tertiary care centers have raised concern about the ability of residents to achieve appropriate levels of competency by the time of graduation. Therefore, simulation has seen an increased role in education in the last decade.

Microsurgical anastomosis is one of the most complex and technically challenging surgical skills. While the need for microanastomosis has decreased due to a multitude of factors, it is still a required skill set in various specialties including neurosurgery, otolaryngology, vascular, and plastic surgery. Multiple simulation models have been devised to allow for better training and improving resident dexterity in microanastomosis. These include cadavers, both animal and human, live animal models, and synthetic models. Each model has its benefits and disadvantages. While cadavers are arguably the most realistic, they are expensive and require proper labs and disposal methods. Live animal models also require proper training and adherence to institutional protocols. They also raise animal welfare ethical questions. Synthetic models with silicone vessels while less realistic offer the best currently available alternative. They are widely available, can be cheap to acquire, and do not require special setups.

In addition to the models, assessment tools are essential for the success of simulation in education. Multiple assessment scales have been used, but only a few have been validated. The Northwestern Objective Microanastomosis Assessment Tool (NOMAT) was developed and validated specifically for microanastomosis for neurosurgical education and has been used by various neurosurgical societies in various national and international meetings.

While there is no current optimal model and assessment scale for microsurgical anastomosis simulation, huge strides forward have been made in the last decade to allow for the adoption of simulation as an acceptable and adequate educational tool.


Simulation Microsurgical Anastomosis NOMAT Duty hours Organized neurosurgery Validity Assessment scale 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Rudy J. Rahme
    • 1
  • Chandan Krishna
    • 2
    • 4
    • 5
  • Mithun G. Sattur
    • 2
    • 4
    • 5
  • Rami James N. Aoun
    • 2
    • 4
    • 5
  • Matthew E. Welz
    • 2
    • 4
    • 5
  • Aman Gupta
    • 2
    • 4
    • 5
  • Bernard R. Bendok
    • 3
    • 4
    • 5
  1. 1.Department of NeurosurgeryNorthwestern Feinberg School and Medicine and McGaw Medical CenterChicagoUSA
  2. 2.Department of NeurosurgeryMayo ClinicPhoenixUSA
  3. 3.Department of Neurological Surgery, Otolaryngology, and RadiologyMayo ClinicPhoenixUSA
  4. 4.Precision Neurotherapeutics LabMayo ClinicPhoenixUSA
  5. 5.Neurosurgery Simulation and Innovation LabMayo ClinicPhoenixUSA

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