Advancing Surgical Skills through Off-the-Job Training in Bypass Surgery: Current Status of STA-MCA Bypass by a Young Neurosurgeon

Abstract

The number of superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass procedures that young neurosurgeons can perform is limited, making off-the-job training (OJT) crucial for acquiring surgical skills. Based on the authors’ training methods and surgical outcomes, this study explored how young neurosurgeons develop these skills. The study focused on end-to-side anastomosis training using a silicon tube that the author employed for OJT. Emphasis was placed on the setup of the anastomosis, defining the roles of the right and left hands in each phase, and continuously refining the surgical procedures. The diameter of the silicon tube and depth of the surgical field were adjusted to simulate actual surgery. Over a four-year period, 807 training sessions were conducted, and 10 cases of 12 STA-MCA bypasses were performed. After 119 sessions, the time for end-to-side anastomosis on the silicon tube was reduced to under 20 min, with the learning curve leveling off thereafter. Although the anastomosis time temporarily increased when the training conditions were altered, it quickly decreased again. A high correlation was observed between the number of training sessions and the middle cerebral artery occlusion time during surgery, following a power approximation curve (r = 0.90). In the fifth case, the occlusion time was reduced to < 20 min. In the ninth case, despite encountering a problem, the occlusion time remained under 20 min. The study demonstrated that with thorough and repeated training, the speed of the anastomosis improved, and the simulated problems also helped foster the ability to remain calm and manage complications. However, maintaining consistent practice can be challenging. It is important to uphold consistent training methods, devise ways to prevent boredom or habituation, and integrate training into routine clinical practice.