Microsurgical Training and Skill Acquisition: A Systematic Review and Meta-analysis.

Background: Simulation in the context of microsurgical training has been explored and examined in the literature with a difference of opinion regarding the optimal model to use for the training and acquisition of microsurgical skills. In some reports, the fidelity of the live animal models offers the opportunity learn surgical as well as surgical-scenario contextualized skills that a less realistic model is unable to offer. In other publications, the skills that can be taught on lower fidelity models are equivalent and offer a more viable and feasible approach to surgical training. Methods: A systematic review of the available microsurgical simulation models was performed with a focus on the acquisition of microsurgical skills measured with validated microsurgical instruments. A meta-analysis of the subgroups was then performed to identify the optimal microsurgical training tool. Results: All training with simulation models resulted in large and statistically significant improvements in microsurgical skills across the range of groupings of microsurgical simulations. This effect was consistently identified across the different groups. Conclusions: Choosing a model to train microsurgical skills may be less important than initially thought. Across the range of living and nonliving biological models and synthetic models, the potential to improve microsurgical skills significantly is available regardless of which simulation model is chosen.