Summary
Background
Microsurgery is a technically demanding aspect of surgery that is integral to a variety
of sub-specialties. Microsurgery is required in high-risk cases where time is limited
and pressure is high, so there is increasing demand for skills acquisition beforehand.
The aim of this review was to analyse the available literature on validated microsurgical
assessment tools.
Methods
Covidence was used to screen papers for inclusion. Keywords included ‘microsurgery’,
‘simulation’, ‘end-product assessment’ and ‘competence’. Inclusion criteria specified
simulation models which demonstrate training and assessment of skill acquisition simultaneously.
Tools which were used for training independently of technical assessment were excluded
and so were tools which did not include a microvascular anastomosis. Each assessment
tool was evaluated for validity, bias, complexity and fidelity and reliability using
PRISMA and SWiM guidelines.
Results
Thirteen distinct tools were validated for use in microsurgical assessment. These
can be divided into overall assessment and end-product assessment. Ten tools assessed
the ‘journey’ of the operation, and three tools were specifically end-product assessments.
All tools achieved construct validity. Criterion validity was only assessed for the
UWOMSA
1
and GRS.
2
Interrater reliability was demonstrated for each tool except the ISSLA
3
and SAMS.
4
Four of the tools addressed demonstrate predictive validity.
4
,
5
,
6
,
7
Conclusion
Thirteen assessment tools achieve variable validity for use in microsurgery. Interrater
reliability is demonstrated for 11 of the 13 tools. The GRS and UWOMSA achieve intrarater
reliability. The End Product Intimal Assessment tool and the Imperial College of Surgical
Assessment device were valid tools for objective assessment of microsurgical skill.
Keywords
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Article info
Publication history
Published online: June 28, 2022
Accepted:
June 21,
2022
Received:
January 14,
2022
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
