The Role of 10-0 Suturing Training under Desktype Microscope for the Mastery of Cerebrovascular Surgery: The Effectiveness of 80,000 Stitches
The Role of 10-0 Suturing Training under Desktype Microscope for the Mastery of Cerebrovascular Surgery: The Effectiveness of 80,000 Stitches
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台式显微镜下10-0缝合训练对脑血管手术掌握的作用：8万针的效果
DOI：
10.2335/scs.37.247
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
K. Tsutsumi
中科院分区：
文献类型：
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作者：
Tomohiro Inoue;N. Kunii;Atsushi Kumakiri;Ryohei Otani;A. Tamura;I. Saito;K. Tsutsumi
如今，由于血管内治疗的数量不断增加以及微创治疗的趋势，与资深神经外科医生相比，年轻的神经外科医生需要以更少的手术量来提高技能。为了克服这些困难，第一作者在资深作者（KT）的指导下，在台式显微镜下使用10-0尼龙进行缝合训练，8年来累计缝合了8万针。此外，初级作者（NK、AK、RO）也接受了同样的训练，积累了10,000-40,000针。通过培训，外科医生能够在10,000针后在监督下实现稳定的STA-MCA吻合，在20分钟闭塞时间内完成STA-MCA吻合，并在30,000针后掌握前循环动脉瘤夹闭（正常尺寸），在50,000针后在监督下实现深部吻合和大动脉瘤夹闭。缝了 80,000 针后，作为主任，每年可以管理 280 例手术病例（夹闭术，50 例；搭桥术，30 例；ICH 切除术，30 例）。尽管提高手术技能的因素有多种，但这种简单、日常、长期的训练可以通过提高高倍率下的灵活性和可操作性来帮助克服脑血管手术技能的陡峭学习曲线。
Nowadays, young neurosurgeons need to brush up their skills with lower surgical case volume compared with what senior neurosurgeons have experienced before due to the increasing number of endovascular treatments as well as the trend toward less invasive treatment. To overcome such difficulties, under the instruction of the senior author (KT), the first author underwent suturing training using 10-0 nylon under desktype microscope, accumulating up to 80,000 stitches over the past 8 years. In addition, the junior author (NK, AK, RO) underwent the same training, accumulating up to 10,000-40,000 stitches. The training resulted in the surgeons being able to achieve stable STA-MCA anastomosis under supervision after 10,000 stitches, STA-MCA anastomosis within 20 minutes occlusion time and mastery of aneurysmal clipping of anterior circulation (normal size) after 30,000 stitches, deep anastomosis and clipping of large aneurysm under supervision after 50,000 stitches. After 80,000 stitches, it was possible to manage 280 surgical cases/year institution (clipping, 50; bypass, 30; ICH removal, 30) as a chief. Although there are various factors to improve surgical skills, this simple, daily and long-term training could help overcome the steep learning curve of cerebrovascular surgical skills by improving dexiterity and maneuverability under high magnification.