Effectiveness of a 4-day intensive course for neurosurgeons in error reduction in microvascular anastomoses.

Introduction: Microvascular anastomosis is a critical but technically demanding skill in neurosurgery, with a long learning curve and high potential for error. Intensive hands-on training, such as that provided by the European Association of Neurosurgical Societies (EANS), aims to improve surgical proficiency, but objective evaluations of such courses are limited. Research question: Does participation in the EANS Step I and Step II microvascular training courses lead to a significant reduction in technical errors during microvascular anastomosis? Material and methods: A pre- and post-intervention study design was used to assess error reduction in participants of the EANS microvascular courses. The 92 participants were evaluated on a chicken end-to-end arterial anastomosis on the first and last days of course by two independent, blinded assessors using the Anastomosis Lapse Index (ALI). Results: In the Step I cohort, the overall median error count decreased by 32.5 % (from 20 to 13.5, P < 0.0001). In the Step II cohort, the reduction was 46.9 % (from 16 to 8.5, P < 0.0001). Back-wall stitches, a critical error, was significantly reduced in both cohorts (P < 0.0001). Discussion and conclusion: Participation in the Step I and Step II EANS courses significantly improved microsurgical performance, as evidenced by reduced technical errors in microvascular anastomosis. Future efforts should focus on refining evaluation tools and on integrating technological innovations such as motion tracking and machine learning for enhanced feedback and long-term skill assessment.