Abstract
Technical skills for superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery are considered to be easily acquired through off-the-job training. To develop optimal practice methods, we investigated which stage of STA-MCA bypass surgery was time-consuming.
Between March 2010 and May 2013, STA-MCA (M4) bypass surgery was performed in 74 cases. Of these cases, this study included 29 cases of anastomosis performed by the author and 28 cases of anastomosis performed by beginners (11 surgeons during the same period). Video recordings of the anastomosis procedure in each case were reviewed, and the procedure was divided into eight segments to measure the time (unit: second) required for each segment. These segments were grouped into the key procedure of four segments and the preparatory stage of the other four segments to compare each segment group between the author and the beginners.
The mean MCA clamping time was 876±82 seconds (mean±standard deviation) for the author and 2127±410 seconds for the beginners. The total duration of the preparatory stage was 91±39 seconds vs. 245±228 seconds, respectively, and the difference in duration was 154 seconds. This study revealed that the beginners are spending substantial time in non-anastomosis procedures, such as handling needles, tools, etc. To smoothly perform STA-MCA bypass surgery, efforts should simultaneously be aimed at reducing the duration of procedures other than anastomosis.
