Importance of male infertility microsurgery training

Male infertility microsurgery (MIM) is technically and mentally challenging, and outcomes are heavily dependent on surgeon’s skills[1]. Training programs in MIM are important for acquisition and improvement of surgeon’s microsurgical skills and outcomes. In this report, we describe our MIM training program, the trainees’ profile and outcomes. Retrospective review of trainees’ demographic data and training evaluation forms. All urologists who attended our MIM training program from May 2015 to April 2016 were included. Briefly, the MIM training program at our institution is a two-week training course offered to urologists interested in male infertility and held in a dedicated MIM training lab. During the first week, the trainees are taught how to manipulate basic microsurgical equipment. They practice under operating microscopes, using a latex practice card, microsurgical instruments and sutures (10-0 and 9-0). During the second week, and depending on their skill levels, the trainees perform MIM procedures, such as vasovasostomy (VV) and vasoepididymostomy (VE) in rats. Our training protocol is approved by the Institutional Review Board, and instructors provide close supervision and continuous evaluation during all phases of the training. Trainees also observe microsurgical cases performed at our institution. Evaluations of microsurgical skills are performed using a structured score form composed of 18 items, in which the lowest score is 18 points and the highest is 90 points. VV and VE patency rates are also reported. We identified 16 urologists that completed our MIM training program and had evaluation data available. Demographic data is shown on table 1. The average time spend in the microsurgical training lab was 72.1 (±28.8) hours, and the average number of rat procedures performed per trainee was 8.9 (±3.6). The patency rates for VV and VE were 90% and 73% respectively. The average final evaluation score was 67.4 (± 7.1) points, and the average improvement from baseline was 21.2 (±3.5) points. No baseline characteristics were predictive of the outcomes. A MIM training program is an effective tool for teaching MIM skills. A well-equipped training lab provides the ideal environment for acquisition of microsurgical skills, even for experienced surgeons.Tabled 1Trainees' characteristicsAge, mean years (±SD)37.5 (±6.9)No previous experience7 (43%)Self-taught6 (37%)Basic training3 (20%)Fellowship0Full practice0Years performing microsurgery: 0-5 years10 (62%)Years performing microsurgery: >56 (38%)Number of MIM cases/week: 0-2 cases11 (68%)Number of MIM cases/week: > 2 cases5 (32%)Academic practice13 (81%)Non-academic practice setting3 (19%) Open table in a new tab