35. Microsurgical Practice with use of Smart Phone Camera as The Microscopic Field: A Training Protocol for Medical Students

Background: Accessibility to microsurgical equipment is a major barrier to proper training of surgeons prior to live patient free flap surgery. A novel technique is presented that uses a smartphone camera as the microscopic field, eliminating the need for an expensive operative microscope for surgical practice. Practice and repetition are the key components of surgical education. A convenient and cost effective simulation protocol could reduce the time frame of the microsurgery learning curve. Furthermore, the adoption of a microsurgical protocol that does not require access to a surgical microscope increases accessibility to aspiring surgeons and promotes repetition of microsurgical techniques. Methods: The Pocket Suture™ smartphone stand is a commercially available device that allows the smart phone camera to be used as magnification. The proposed education protocol included suture practice, vessel dissection, free tissue transfer in nonliving animal models, with vessel anastomosis and patency confirmation performed with a smartphone camera for field magnification. Video of the suturing technique allowed feedback from the mentor. Results: A progressive suturing protocol leading to the ability to perform microsurgical anastomosis on non living animal models was developed. The basic costs for the stand, instrument set and suture were less than $500. Conclusion: This protocol allows medical students interested in plastic surgery early exposure to advanced technical challenges that may solidify their specialty choice. The low cost eliminates many barriers to early microsurgery training. The protocol may also provide program directors another data point for resident recruitment in the post USMLE step one score era.