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INTRODUCTION: As surgical technologies grow, so too do demands on surgical trainees to master increasing numbers of skill sets. With the rise of endovascular surgery, trainees have fewer opportunities to practice open vascular techniques in the operating room. Simulation can bridge this gap. However, existing published open vascular simulation curricula are basic or based on expensive models. METHODS: We iteratively developed an open vascular skills curriculum for second-year surgery residents comprising six 2-hour sessions. We refined the curriculum based on feedback from learners and faculty. The curriculum required skilled facilitators, vascular instruments, and tissue models. We evaluated the latest iteration with a survey and by assessing participants technical skills using the Objective Structured Assessment of Technical Skills (OSATS) form. RESULTS: Over the past 10 years, 101 residents have participated in the curriculum. Nine of 13 residents who participated in the latest curricular iteration completed the survey. All respondents rated the sessions as excellent and strongly agreed that they had improved their abilities to perform anastomoses with tissue and prosthetic. Facilitators completed 18 OSATS forms for residents in the fifth and sixth sessions of the latest iteration. Residents scored well overall, with a median 26.5 (interquartile range: 24-29) out of a possible score of 35, with highest scores on knowledge of instruments. DISCUSSION: This simulation-based curriculum facilitates open vascular surgical skill acquisition among surgery residents. The curriculum allows residents to acquire critical vascular skills that are challenging to learn in an increasingly demanding operative setting.

Purpose: To investigate whether individuals with long‐term reduced stereopsis were able to obtain the same level of surgical skills in simulated vitreoretinal surgery on the Eyesi Surgical Simulator as individuals with normal stereopsis. Methods: Twenty‐four medical students were recruited and divided into two groups according to their degree of stereopsis: Group 1 (n = 12) included subjects with normal stereopsis (60 arcsec or lower) and Group 2 (n = 12) included subjects with reduced stereopsis (120 arcsec or higher). Stereopsis was tested using the TNO test (Lameris Ootech BV, Nieuwegein, the Netherlands). The participants were trained in virtual reality‐simulated vitreoretinal surgery and continuously measured using a test with solid validity evidence and a pre‐defined pass–fail score. All data were analysed using the Wilcoxon rank sum test. Results: We observed no differences in overall performance scores for any of the four modules. The participants with reduced stereopsis used 5.8 more attempts in bimanual training (p = 0.04), 8.8 more attempts in removal of posterior hyaloid (p = 0.04), 9.1 more attempts in navigation training (p = 0.20) and 0.3 fewer attempts in removal of internal limiting membrane (p = 0.69). Conclusion: The final performance scores on the Eyesi Surgical Simulator were independent of the degree of stereopsis. However, the number of attempts to achieve the pre‐defined pass–fail score increased significantly with reduced stereopsis in two of four modules. These results indicate that a high degree of stereopsis is not necessary to become proficient in microsurgery but may prolong the learning curve. [ABSTRACT FROM AUTHOR]

Background: Simulation-based training plays a significant role in surgical education, especially in minimally invasive pediatric surgery and urology. This study aimed to evaluate a novel 3D-printed model as training tool for endoscopic injection of bulking agent. Methods: Forty-three attendees and ten teaching faculty members were invited to complete a post hoc questionnaire after completing training sessions using the Fish Tank Simulation Model (FTSM). The survey consisted of a 7-question 5-point Likert scale to assess the model's realism (face validity) and its effectiveness as training tool (content validity). Results: Regarding the training status, 20/53 (37.7%) participants were fellow and/or specialist in pediatric surgery and 33/53 (62.3%) were surgeons in training. Their level of confidence in endoscopic injection procedure was defined as novice (< 10 procedures per year) in 33/53 (62.3%), intermediate (10–20 procedures per year) in 10/53 (18.9%), and expert (> 20 procedures per year) in 10/53 (18.9%). Regarding both face validity and content validity assessments, no statistically significant differences were found between scores given by novice vs intermediate/expert groups. Similarly, no statistically significant differences emerged between scores given by participant vs faculty groups assessing the content validity of the FTSM. The FTSM was considered a good teaching tool for beginners by 44/53 (83%) and for pediatric surgeons/urologists by 38/53 (71.7%). Conclusions: The 3D-printed Fish Tank Simulation Model proved to be a valuable, high-fidelity, easily accessible, cost-effective, hygienic, and domestic-use training tool for pediatric surgeons/urologists conducting the procedure. The model's user-friendly design and realistic environment enhanced learning opportunities for trainees, regardless of their experience level or training status. Nevertheless, further development is necessary, particularly in enhancing the realism of the ureteral hiatus and reproducing more complex anatomy, to make it beneficial for the training of advanced surgeons. [ABSTRACT FROM AUTHOR]

The use of 3D-printed models in simulation-based training and planning for vascular surgery is gaining interest. This study aims to provide an overview of the current applications of 3D-printing technologies in vascular surgery. We performed a systematic review by searching four databases: PubMed, Web of Science, Scopus, and Cochrane Library (last search: 1 March 2024). We included studies considering the treatment of vascular stenotic/occlusive or aneurysmal diseases. We included papers that reported the outcome of applications of 3D-printed models, excluding case reports or very limited case series (≤5 printed models or tests/simulations). Finally, 22 studies were included and analyzed. Computed tomography angiography (CTA) was the primary diagnostic method used to obtain the images serving as the basis for generating the 3D-printed models. Processing the CTA data involved the use of medical imaging software; 3DSlicer (Brigham and Women's Hospital, Harvard University, Boston, MA), ITK-Snap, and Mimics (Materialise NV, Leuven, Belgium) were the most frequently used. Autodesk Meshmixer (San Francisco, CA, USA) and 3-matic (Materialise NV, Leuven, Belgium) were the most frequently employed mesh-editing software during the post-processing phase. PolyJet™, fused deposition modeling (FDM), and stereolithography (SLA) were the most frequently employed 3D-printing technologies. Planning and training with 3D-printed models seem to enhance physicians' confidence and performance levels by up to 40% and lead to a reduction in the procedure time and contrast volume usage to varying extents. [ABSTRACT FROM AUTHOR]

Introduction: Human error is one of the leading causes of medical error. It is estimated that human error leads to between 250,000 and 440,000 deaths each year. Medical simulation has been shown to improve the skills and confidence of clinicians and reduce medical errors. Surgical simulation is critical for training surgeons in complicated procedures and can be particularly effective in skill retention. Methods: The interactive Medical Simulation Toolkit (iMSTK) is an open source platform with position-based dynamics, continuous collision detection, smooth particle hydrodynamics, integrated haptics, and compatibility with Unity and Unreal, among others. iMSTK provides a wide range of real-time simulation capabilities with a flexible open-source license (Apache 2.0) that encourages adoption across the research and commercial simulation communities. iMSTK uses extended position-based dynamics and an established collision and constraint implementations to model biological tissues and their interactions with medical tools and other tissues. Results: The platform demonstrates performance, that is, compatible with realtime simulation that incorporates both visualization and haptics. iMSTK has been used in a variety of virtual simulations, including for laparoscopic hiatal hernia surgery, laparoscopic cholecystectomy, osteotomy procedures, and kidney biopsy procedures. Discussion: iMSTK currently supports building simulations for a wide range of surgical scenarios. Future work includes expanding Unity support to make it easier to use and improving the speed of the computation to allow for larger scenes and finer meshes for larger surgical procedures. [ABSTRACT FROM AUTHOR]

Lack of access to pediatric medical devices and innovative technology contributes to global disparities in children's surgical care. There are currently many barriers that prevent access to these technologies in low- and middle-income countries (LMICs). Technologies that were designed for the needs of high-income countries (HICs) may not fit the resources available in LMICs. Likewise, obtaining these devices are costly and require supply chain infrastructure. Once these technologies have reached the LMIC, there are many issues with sustainability and maintenance of the devices. Ideally, devices would be created for the needs and resources of LMICs, but there are many obstacles to innovation that are imposed by institutions in both HICs and LMICs. Fortunately, there is a growing interest for development of this space, and there are many examples of current technologies that are paving the way for future innovations. Innovations in simulation-based training with incorporated learner self-assessment are needed to fast-track skills acquisition for both specialist trainees and non-specialist children's surgery providers, to scale up access for the larger population of children. Pediatric laparoscopy and imaging are some of the innovations that could make a major impact in children's surgery worldwide.

Cleft alveolar bone graft surgery is technically challenging to perform as well as difficult to learn and teach. A high-fidelity cleft alveolar bone graft simulator was previously developed. However, further evaluation of the simulator is necessary to assess its efficacy. Two cleft simulation workshops were conducted in which participants were led through a simulated cleft alveolar bone graft. The first simulation workshop involved six plastic surgery trainees. The second workshop involved 43 practicing cleft surgeons. The participants were provided with a Likert-type questionnaire assessing the simulators' features, realism, and value as a training tool. The change in self-reported confidence was assessed by providing each participant with a pre- and post-simulation confidence questionnaire. There was overall agreement in the realism of the simulators' features (average score of 4.67 and 3.80 out of 5 for the trainees and surgeons, respectively). There was overall agreement to strong agreement in the simulators value as a training tool (average score of 5 and 4.43 out of 5 for the trainees and surgeons, respectively). The self-reported confidence increased for all questionnaire items for both the trainees and surgeons. This was significant (p < 0.05) for five out of eight and all questionnaire items for the trainees and surgeons, respectively. The magnitude of the confidence increase was generally greater for less experienced participants. The cleft alveolar bone graft simulator was found to be realistic and valuable as a training platform. Use of the simulator improved self-reported confidence in cleft alveolar bone graft surgery. [ABSTRACT FROM AUTHOR]

To elucidate the design and fabrication methodologies employed in creating a personalized cleft lip simulation model, primarily intended for enhancing surgical training and diverse applications. The study further sought to assess the viability of integrating this simulation model into undergraduate oral experiments and instructional settings. Facial data from individuals with cleft lip conditions were acquired using a scanner. Subsequent stages involved reverse engineering and the utilization of 3D printing technology to generate a cleft lip silicone simulation model. The molding process entailed injecting silicone into a polylactic acid mold. The study enrolled 53 undergraduate students majoring in dentistry, who were randomly assigned to either a control or experimental group. A dedicated instructor guided each group independently, employing a combination of multiple-choice tests and surveys to gauge real-time evaluations and discern inter-group disparities. We successfully designed and produced a personalized cleft lip simulation model, demonstrating notable efficacy in the context of cleft lip experimental teaching. Statistical analysis revealed a significant difference (P < 0.05) in the scores of the experimental group students on multiple-choice questions pertaining to cleft lip surgical procedures. Survey outcomes indicated that the experimental group students exhibited higher confidence levels in cleft lip surgery, as reflected from their responses to relevant questions, compared to the traditional group students. These differences were statistically significant (P < 0.05). The simulation model developed in this study emerges as a reliable and cost-effective training and teaching tool for cleft lip surgery. [ABSTRACT FROM AUTHOR]

Objective: To assess the ability of current 3D printing technology to generate a craniofacial bony and soft tissue anatomical model for use in simulating the performance of a fronto-orbital advancement (FOA) osteotomy and then to further assess the value of the model as an educational tool. Design: Anatomic models were designed with a process of serial anatomic segmentation/design, 3D printing, dissection, and device refinement. A validation study was conducted with 5 junior and 5 senior plastic surgery residents. The validation study incorporated a multiple-choice Knowledge Assessment test (KA), an Objective Structured Assessment of Technical skills (OSATs), a Global Rating Scale (GRS) and a Michigan Standard Simulation Experience Scale (MiSSES). We compared the scores of both the junior and senior residents and compared junior resident scores, before and after viewing a lecture/demonstration. Results: MiSSES showed high face validity with a score of 85.1/90, signifying high satisfaction with the simulator learning experience. Simulation and the lecture/demonstration improved the junior resident average KA score from 5.6/10 to 9.6/10 (P =.02), OSATs score from 32.4/66 to 64.4/66 (P <.001) and GRS score from 13.9/35 to 27.5/35 (P <.001). The senior residents OSATs score of 56.3/66 was higher than the pre-lecture juniors (32.4/66) (P <.001), but lower than the post-lecture juniors (64.4/66) (P <.001). Conclusion: We have successfully fabricated a 3D printed craniofacial simulator capable of being used as an educational tool alongside traditional surgical training. Next steps would be improving soft tissue realism, inclusion of patient and disease specific anatomy and creation of models for other surgical specialties. [ABSTRACT FROM AUTHOR]

Adequate surgical margins are essential in oral cancer treatment, this is, however, difficult to appreciate during training. With advances in training aids, we propose a silicone-based surgical simulator to improve training proficiency for the ablation of oral cavity cancers. A silicone-based tongue cancer model constructed via a 3D mold was compared to a porcine tongue model used as a training model. Participants of varying surgical experience were then asked to resect the tumors with clear margins, and thereafter asked to fill out a questionnaire to evaluate the face and content validity of the models as a training tool. Eleven participants from the Otolaryngology-Head and Neck Surgery unit were included in this pilot study. In comparison to the porcine model, the silicone model attained a higher face (4 vs. 3.6) and content validity (4.4 vs. 4.1). Tumor consistency was far superior in the silicone model compared to the porcine model (4.1 vs. 2.8, p = 0.0042). Fellows and staff demonstrated a better margin clearance compared to residents (median 3.5 mm vs. 1.0 mm), and unlike the resident group, there was no incidence of positive margins. The surgical simulation was overall useful for trainees to appreciate the nature of margin clearance in oral cavity cancer ablation. [ABSTRACT FROM AUTHOR]

Purpose: In virtual surgery, the appearance of 3D models constructed from CT images lacks realism, leading to potential misunderstandings among residents. Therefore, it is crucial to reconstruct realistic endoscopic scene using multi-view images captured by an endoscope. Methods: We propose an Endoscope-NeRF network for implicit radiance fields reconstruction of endoscopic scene under non-fixed light source, and synthesize novel views using volume rendering. Endoscope-NeRF network with multiple MLP networks and a ray transformer network represents endoscopic scene as implicit field function with color and volume density at continuous 5D vectors (3D position and 2D direction). The final synthesized image is obtained by aggregating all sampling points on each ray of the target camera using volume rendering. Our method considers the effect of distance from the light source to the sampling point on the scene radiance. Results: Our network is validated on the lung, liver, kidney and heart of pig collected by our device. The results show that the novel views of endoscopic scene synthesized by our method outperform existing methods (NeRF and IBRNet) in terms of PSNR, SSIM, and LPIPS metrics. Conclusion: Our network can effectively learn a radiance field function with generalization ability. Fine-tuning the pre-trained model on a new endoscopic scene to further optimize the neural radiance fields of the scene, which can provide more realistic, high-resolution rendered images for surgical simulation. [ABSTRACT FROM AUTHOR]

Objective: To identify specific areas for improvement in cleft lip repair teaching. Design: Secondary analysis of prospectively-collected, blinded data. Setting: Three residency programs rotating at a single academic children's hospital. Participants: Plastic surgery residents, and craniofacial/pediatric plastic surgery fellows. Main Outcome Measures: Mean scores for each skill in an 18-item Unilateral Cleft Lip Repair competency assessment tool (UCLR) (1–3 scale for each item) were rank ordered. Correlation between level of training (PGY) and performance on steps of the procedure was examined using Pearson R. Results: Simulation participants (n = 26) scored highest on skills in the "Marking" subscale (2.38–2.63 mean score). Procedural steps that scored lowest were: closing the nasal floor (2.00), repairing oral mucosa (2.15) and avoiding over/under-dissection (2.19). Interestingly, none of these skills correlated with PGY, suggesting they do not improve with training. Conclusions: These results suggest that marking cleft lip repair is taught well in our current teaching environment, while steps like closing the nasal floor and repairing the oral mucosa are taught less well. Improved teaching of these steps could be achieved with deliberate instruction, video, digital simulation, and high fidelity simulation. [ABSTRACT FROM AUTHOR]

Objectively examine the effect of 3D-Augmented Reality anatomic review on craniotomy planning among neurosurgical residents as it pertains to craniotomy size, skull positioning, and knowledge of significant anatomic relationships. Postgraduate year 1-7 neurosurgery residents were instructed to review standard 2D radiographs, pin a skull, and tailor a craniotomy for 6 different lesions and case vignettes. Participants then reviewed the lesion in a 3D-augmented reality (AR) environment, followed by repeating the craniotomy station for a variety of lesion types and locations (superficial, subcortical, deep, skull base). Quiz with case-specific anatomic and surgical questions followed by an exit survey for qualitative impressions. Eleven of thirteen eligible residents participated. Skull position significantly changed in 5 out of 6 cases after 3D-AR view (P < 0.05, 20° angular adjustment). No significant change in incision length or craniotomy size. Subgroup analysis of junior versus senior residents revealed that craniotomy size was significantly altered in 2 out of 6 cases. Qualitative testimonials (Likert scale 5 = strongly agree) reported a change in craniotomy approach after 3D-review (3.5), improved appreciation of anatomy (4.2), increased confidence in surgical approach (4.33 junior residents, 3.5 senior residents), smaller incision (3.5 junior residents, 1.75 senior residents), better appreciation of white matter tracts (4.6). The augmented reality platform offers a medium to examine surgical planning skills. Residents uniformly appreciated 3D-AR as a valuable tool for improving appreciation of critical anatomic structures and their relationship to lesional pathology. 3D-AR review significantly altered skull positioning for various lesions and craniotomy approaches, particularly among junior residents. [ABSTRACT FROM AUTHOR]

Goal: Vascular surgical procedures are challenging and require proficient suturing skills. To develop these skills, medical training simulators with objective feedback for formative assessment are gaining popularity. As hardware advancements offer more complex, unique sensors, determining effective task performance measures becomes imperative for efficient suturing training. Methods: 97 subjects of varying clinical expertise completed four trials on a suturing skills measurement and feedback platform (SutureCoach). Instrument handling metrics were calculated from electromagnetic motion trackers affixed to the needle driver. Results: The results of the study showed that all metrics significantly differentiated between novices (no medical experience) from both experts (attending surgeons/fellows) and intermediates (residents). Rotational motion metrics were more consistent in differentiating experts and intermediates over traditionally used tooltip motion metrics. Conclusions: Our work emphasizes the importance of tool motion metrics for open suturing skills assessment and establishes groundwork to explore rotational motion for quantifying a critical facet of surgical performance.

Lateral-access spine surgery has many benefits, but adoption has been limited by a steep learning curve. Virtual reality (VR) is gaining popularity and lends itself as a useful tool in enhancing neurosurgical resident education. We thus sought to assess whether VR-based simulation could enhance the training of neurosurgery residents in lateral spine surgery. Neurosurgery residents completed a VR-based lateral spine module on lateral patient positioning and performing lateral lumbar interbody fusion using the PrecisionOS VR system on the Meta Quest 2 headset. Simulation occurred 1×/week every other week for a total of 3 simulations over 6 weeks. Pre- and postintervention surveys as well as intrasimulation performance metrics were assessed over time. The majority of resident participants showed improvement in performance scores, including an automated PrecisionOS precision score, number of radiographs used within the simulation, and time to completion. All participants showed improvement in comfort with anatomic landmarks for lateral access surgery, confidence performing lateral surgery without direct supervision, and assessing fluoroscopy in spine surgery for hardware placement and image interpretation. Participant perception on the utility of VR as an educational tool also improved. VR-based simulation enhanced neurosurgical residents' ability to understand lateral access surgery. Immersive surgical simulation resulted in improved resident confidence with surgical technique and workflow, perceived improvement in anatomical knowledge, and simulation performance scores. Trainee perceptions on virtual simulation and training as a curriculum supplement also improved following completion of VR training. [ABSTRACT FROM AUTHOR]

In the forefront of ophthalmic innovation, biomimetic 3D printing and bioprinting technologies are redefining patient-specific therapeutic strategies. This critical review systematically evaluates their application spectrum, spanning oculoplastic reconstruction, retinal tissue engineering, corneal transplantation, and targeted glaucoma treatments. It highlights the intricacies of these technologies, including the fundamental principles, advanced materials, and bioinks that facilitate the replication of ocular tissue architecture. The synthesis of primary studies from 2014 to 2023 provides a rigorous analysis of their evolution and current clinical implications. This review is unique in its holistic approach, juxtaposing the scientific underpinnings with clinical realities, thereby delineating the advantages over conventional modalities, and identifying translational barriers. It elucidates persistent knowledge deficits and outlines future research directions. It ultimately accentuates the imperative for multidisciplinary collaboration to enhance the clinical integration of these biotechnologies, culminating in a paradigm shift towards individualized ophthalmic care. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Many types of congenital heart disease are amenable to surgical repair or palliation. The procedures are often challenging and require specific surgical training, with limited real-life exposure and often costly simulation options. Our objective was to create realistic and affordable 3D simulation models of the heart and vessels to improve training. METHODS We created moulded vessel models using several materials, to identify the material that best replicated human vascular tissue. This material was then used to make more vessels to train residents in cannulation procedures. Magnetic resonance imaging views of a 23-month-old patient with double-outlet right ventricle were segmented using free open-source software. Re-usable moulds produced by 3D printing served to create a silicone model of the heart, with the same material as the vessels, which was used by a heart surgeon to simulate a Rastelli procedure. RESULTS The best material was a soft elastic silicone (Shore A hardness 8). Training on the vessel models decreased the residents' procedural time and improved their grades on a performance rating scale. The surgeon evaluated the moulded heart model as realistic and was able to perform the Rastelli procedure on it. Even if the valves were poorly represented, it was found to be useful for preintervention training. CONCLUSIONS By using free segmentation software, a relatively low-cost silicone and a technique based on re-usable moulds, the cost of obtaining heart models suitable for training in congenital heart defect surgery can be substantially decreased. [ABSTRACT FROM AUTHOR]

Hypospadias has drawn increasing attention due to its prevalence, complex etiology, and significant impacts on psychological and sexual quality of life. This comprehensive review delves into the facets of hypospadias management, exploring pivotal themes that shape present understanding and practice. We demonstrate potential explanatory factors for its incidence through an analysis of geographic, genetic, and environmental influences. We then contextualize care by exploring historical and evolving surgical techniques, and highlight that advances in surgical approaches employ a spectrum of repair strategies. Innovation in surgical training, with a focus on simulation-based methodologies, offers a bridge between didactic learning and real-world application, which is particularly relevant due to the demonstrated effect of personal experience with hypospadias repair outcomes. Considering the importance of mentorship, case exposure, and hands-on practice, a holistic understanding of expertise cultivation at each training stage is essential. Lastly, patient-centric outcomes research must take center stage, particularly as the impact of our interventions on children with hypospadias will be judged by them as adults. Shifting from solely surgeon-reported outcomes to patient-reported outcomes is emphasized in the review, allowing for a more comprehensive assessment of the influence of surgical interventions across the lifespan. Integrating patients' perspectives refines surgical decision-making to align with expectations, ultimately enhancing overall satisfaction. Our multi-pronged exploration of advancements in hypospadias underscores the symbiotic relationship between evolving surgical techniques, training methodologies, personal experience, and patientreported outcomes. As the field progresses, these insights will collectively contribute to optimizing hypospadias care, advancing both medical practice and patient well-being. [ABSTRACT FROM AUTHOR]

Background. Understanding the severity of the disease from the parents' perspective can lead to better patient outcomes, improving both the child's health-related quality of life and the family's quality of life. The implementation of 3-dimensional (3D) modeling technology in care is critical from a translational science perspective. Aim. The purpose of this study is to determine the effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases. Additionally, we aim to identify challenges and potential solutions related to this innovative technology. Methods. The study is a two-group pretest-posttest randomized controlled trial protocol. The sample size is 15 in the experimental group and 15 in the control group. The experimental group's heart models will be made from their own computed tomography (CT) images and printed using a 3D printer. The experimental group will receive surgical simulation and preoperative parent education with their 3D heart model. The control group will receive the same parent education using the standard anatomical model. Both groups will complete the Sociodemographic Information Form, the Surgical Simulation Evaluation Form - Part I-II, and the Pediatric Quality of Life Inventory (PedsQL) Family Impacts Module. The primary outcome of the research is the average PedsQL Family Impacts Module score. Secondary outcome measurement includes surgical success and patient outcomes. Separate analyses will be conducted for each outcome and compared between the intervention and control groups. Conclusions. Anomalies that can be clearly understood by parents according to the actual size and dimensions of the child's heart will affect the preoperative preparation of the surgical procedure and the recovery rate in the postoperative period. [ABSTRACT FROM AUTHOR]

The drive to improve surgical proficiency through advanced simulation-based training has gained momentum. This meta-analysis systematically evaluated evidence regarding the impact of plastic surgery-related simulation on the performance of residents. A systematic search of PubMed, Web of Science, and Cochrane Library and review of articles was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. An inverse-variance random-effects model was used to combine study estimates to account for between-study variability. Objective structured assessment of technical skills (OSATS) scores and subjective confidence scores were used to assess the impact of the simulation with positive changes from the baseline indicating better outcomes. Eighteen studies pooling 367 trainees who participated in various simulations were included. Completion of simulation training was associated with significant improvement in subjective confidence scores with a mean increase of 1.44 units (95% CI: 0.93 to 1.94, P < 0.001), and in OSATS scores, with a mean increase of 1.24 units (95% CI: 0.87 to 1.62, P < 0.001), both on a 1–5 scale. Participants reported high satisfaction scores (mean = 4.76 units, 95% CI = 4.61 to 4.91, P = 0.006), also on a 1–5 scale. Participation in surgical simulation markedly improved objective and subjective scoring metrics for surgical trainees. Several simulation devices are available for honing surgical skills, with the potential for advancements. The evidence demonstrates the effectiveness of simulations; thus, incorporating simulation into training curricula should be a priority in the field of plastic surgery. [ABSTRACT FROM AUTHOR]

The burgeoning field of gender affirmation surgery (GAS) has become increasingly complex, challenging plastic surgeons to meet high standards for their patients. During the COVID-19 pandemic, the emphasis on remote learning ushered in the increased use of surgical simulation training, offering residents the opportunity to trial challenging procedures before treating patients. This systematic review seeks to summarize current simulation training models used in GAS. A systematic review was conducted according to PRISMA-P guidelines using the following databases: PubMed , Medline , Scopus , Embase , Web of Science , and Cochrane. Inclusion criteria were English-language peer-reviewed articles on surgical simulation techniques or training related to the field of gender surgery. Skills and techniques taught and assessed, model type, equipment, and cost were abstracted from articles. Our search criteria identified 1650 articles, 10 of which met the inclusion criteria for data extraction. Simulation models included those that involved cadavers (n = 2), synthetic benchtop (n = 5), augmented/virtual reality (n = 2), and 3D-printed interfaces (n = 1). The most common procedure involved breast or pectoral reconstruction and/or augmentation (n = 5), followed by vaginal reconstruction (n = 3). One simulation model involved facial GAS. All models focused on surgical technique and anatomy, three on suture skills or knot-tying, and one on surgical decision-making. The evolving field of GAS requires that plastic surgery trainees be knowledgeable on surgical techniques surrounding this scope of practice. Surgical simulation not only teaches residents how to master techniques but also helps address the sensitive nature of GAS. [ABSTRACT FROM AUTHOR]

Purpose: Computer-assisted surgical systems provide support information to the surgeon, which can improve the execution and overall outcome of the procedure. These systems are based on deep learning models that are trained on complex and challenging-to-annotate data. Generating synthetic data can overcome these limitations, but it is necessary to reduce the domain gap between real and synthetic data. Methods: We propose a method for image-to-image translation based on a Stable Diffusion model, which generates realistic images starting from synthetic data. Compared to previous works, the proposed method is better suited for clinical application as it requires a much smaller amount of input data and allows finer control over the generation of details by introducing different variants of supporting control networks. Results: The proposed method is applied in the context of laparoscopic cholecystectomy, using synthetic and real data from public datasets. It achieves a mean Intersection over Union of 69.76%, significantly improving the baseline results (69.76 vs. 42.21%). Conclusions: The proposed method for translating synthetic images into images with realistic characteristics will enable the training of deep learning methods that can generalize optimally to real-world contexts, thereby improving computer-assisted intervention guidance systems. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery demands high precision and skill, necessitating effective training protocols that account for factors such as hand dominance. This study investigates the impact of hand dominance on the acquisition and proficiency of laparoscopic surgical skills, utilizing a novel assessment method that combines Network Models and electromyography (EMG) data. Methods: Eighteen participants, comprising both medical and non-medical students, engaged in laparoscopic simulation tasks, including peg transfer and wire loop tasks. Performance was assessed using Network Models to analyze EMG data, capturing muscle activity and learning progression. The NASA Task Load Index (TLX) was employed to evaluate subjective task demands and workload perceptions. Results: Our analysis revealed significant differences in learning progression and skill proficiency between dominant and non-dominant hands, suggesting the need for tailored training approaches. Network Models effectively identified patterns of skill acquisition, while NASA-TLX scores correlated with participants' performance and learning progression, highlighting the importance of considering both objective and subjective measures in surgical training. Conclusions: The study underscores the importance of hand dominance in laparoscopic surgical training and suggests that personalized training protocols could enhance surgical precision, efficiency, and patient outcomes. By leveraging advanced analytical techniques, including Network Models and EMG data analysis, this research contributes to optimizing clinical training methodologies, potentially revolutionizing surgical education and improving patient care. [ABSTRACT FROM AUTHOR]

Background: A prospective IDEAL stage 2a pilot study was carried out at a tertiary care center to evaluate the reliability of a homemade laparoscopic endotrainer, following the MISTEL and IDEAL framework guidelines. Methods: The validated modified (MISTELS) score was used to test the reliability of a low‐cost laparoscopic trainer with commonly found components built by surgeons. Basic household materials including a cellular phone (camera source), wifi (linking source) and freely available webcam apps were used for construction. Five basic laparoscopic skills were performed by general surgery resident volunteers with minimal (1–6 months') laparoscopic surgery experience and tested and retested based on efficiency and precision. To determine interrater reliability, two trained observers scored all subjects. The Cronbach alpha test was used to test for internal consistency between tasks. The Interclass correlation coefficient is used for test and retest reliability. Results: 15 (80% male, mean age 28 ± 5 years) residents were included. The interrater and test–retest reliabilities for the total scores of the basic laparoscopic skills tests were 0.952 (95% CI, 0.895–0.981) and 0.64 (95% CI, 0.35–0.77), respectively. The Cronbach Alpha for the first assessment test and retest was 0.83. The MISTELS metrics had excellent reliability, exceeding the threshold level of 0.8. Conclusion: It is possible to assemble a low‐cost, reliable trainer at home to enhance laparoscopic skills during residency. [ABSTRACT FROM AUTHOR]

Our study explores the integration of three-dimensional (3D) virtual reality (VR) and 3D printing in neurosurgical preoperative planning. Traditionally, surgeons relied on two-dimensional (2D) imaging for complex neuroanatomy analyses, requiring significant mental visualization. Fortunately, nowadays advanced technology enables the creation of detailed 3D models from patient scans, utilizing different software. Afterwards, these models can be experienced through VR systems, offering comprehensive preoperative rehearsal opportunities. Additionally, 3D models can be 3D printed for hands-on training, therefore enhancing surgical preparedness. This technological integration transforms the paradigm of neurosurgical planning, ensuring safer procedures. [ABSTRACT FROM AUTHOR]

There is currently a shift in surgical training from traditional methods to simulation-based approaches, recognizing the necessity of more effective and controlled learning environments. This study introduces a completely new 3D-printed modular system for endovascular surgery training (M-SET), developed to allow various difficulty levels. Its design was based on computed tomography angiographies from real patient data with femoro-popliteal lesions. The study aimed to explore the integration of simulation training via a 3D model into the surgical training curriculum and its effect on their performance. Our preliminary study included 12 volunteer trainees randomized 1:1 into the standard simulation (SS) group (3 stepwise difficulty training sessions) and the random simulation (RS) group (random difficulty of the M-SET). A senior surgeon evaluated and timed the final training session. Feedback reports were assessed through the Student Satisfaction and Self-Confidence in Learning Scale. The SS group completed the training sessions in about half time (23.13 ± 9.2 min vs. 44.6 ± 12.8 min). Trainees expressed high satisfaction with the training program supported by the M-SET. Our 3D-printed modular training model meets the current need for new endovascular training approaches, offering a customizable, accessible, and effective simulation-based educational program with the aim of reducing the time required to reach a high level of practical skills. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Virtual training simulators have been introduced in several surgical disciplines to improve residents' abilities. Through the use of the LapSim® virtual training simulator (Surgical Science, Göteborg, Sweden), this study aims to plan an effective learning path in minimally invasive thoracic and general surgery. METHODS All thoracic and general surgery trainees in their 1st and 2nd year of residency at the University of Insubria were enrolled and randomized into 2 groups: residents undergoing an intensive twice-a-week virtual training programme (group A: n  = 8) and those undergoing a once-weekly non-intensive virtual training programme (group B: n  = 9). The virtual training programme was divided into 4 modules, each of 12 weeks. In the 1st module, trainees repeated grasping, cutting, clip application, lifting and grasping, and fine dissection exercises during each training session. Seal-and-cut exercise was performed as the initial and final test. Data on surgical manoeuvres (time and on mistakes) were collected; intra- and inter-group comparisons were planned. RESULTS No significant differences were observed between groups A and B at the 1st session, confirming that the 2 groups had similar skills at the beginning. After 12 weeks, both groups showed improvements, but comparing data between initial and final test, only Group A registered a significant reduction in total time (P -value = 0.0015), left (P -value = 0.0017) and right (P -value = 0.0186) instrument path lengths, and in left (P -value = 0.0010) and right (P -value = 0.0073) instrument angular path lengths, demonstrating that group A acquired greater precision in surgical manoeuvres. CONCLUSIONS Virtual simulator training programme performed at least twice a week was effective for implementing basic surgical skills required for the trainee's professional growth. Additional virtual training modules focused on more complex exercises are planned to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Introduction: Surgical training using simulation can fill gaps in traditional surgical residency learning. We hypothesize that arthroscopy training conducted on a virtual reality simulator will be preferred by orthopaedic surgery residents over a traditional dry lab simulation model. Methods: 38 orthopaedic surgery residents at a single U.S. residency program were randomized to train for a shoulder arthroscopy procedure using either a virtual reality simulator or a table-top dry lab simulator. Training and learning preferences were then asked of the resident participants. Results: Junior residents were likely to report training preference for the virtual reality simulator compared to senior residents [15/24 (62.5%) v. 8/14 (57.1%); P =.043]. Simulator preference was not influenced by subspecialty interest, prior arthroscopy experience, or simulator experience. Virtual reality simulation was associated with positive attitude towards arthroscopy and high chance of reporting learning gains on general arthroscopic understanding. Senior residents were 4.7 times more likely than juniors to report learning gains via staff discussion pre- and post-operatively. A majority of residents [34/38 (89.5%)] reported, however, wanting more simulation for training surgical skills. Conclusion: Simulation is a desired and potentially valuable adjunct to training orthopaedic residents in arthroscopy. Training needs do evolve; and junior arthroscopists may benefit more from virtual reality platforms for general skills. Senior residents preferred dry lab simulation, possibly because it allowed for handling of actual instruments and implants. [ABSTRACT FROM AUTHOR]

Background Perforator dissection and flap elevation are routinely performed for microsurgical reconstruction; however, there is a steep learning curve to mastering these technical skills. Though live porcine models have been utilized as a microsurgical training model, there are significant drawbacks that limit their use, including cost, limited ability for repetition, and obstacles associated with animal care. Here we describe the creation of a novel perforator dissection model using latex augmented non-living porcine abdominal walls. We provide anatomic measurements that demonstrate valuable similarities and differences to human anatomy to maximize microsurgical trainee practice. Methods Six latex-infused porcine abdomens were dissected based on the deep cranial epigastric artery (DCEA). Dissection was centered over the abdominal wall mid-segment between the second and fourth nipple line. Dissection steps included exposure of lateral and medial row perforators, incision of anterior rectus sheath with perforator dissection, and dissection of DCEA pedicle. DCEA pedicle and perforator measurements were compared with deep inferior epigastric artery (DIEA) data in the literature. Results An average of seven perforators were consistently identified within each flap. Assembly of the model was performed quickly and allowed for two training sessions per specimen. Porcine abdominal walls demonstrate similar DCEA pedicle (2.6 ± 0.21 mm) and perforator (1.0 ± 0.18 mm) size compared with a human's DIEA (2.7 ± 0.27 mm, 1.1 ± 0.85 mm). Conclusion The latex-infused porcine abdominal model is a novel, realistic simulation for perforator dissection practice for microsurgical trainees. Impact on resident comfort and confidence within a microsurgical training course is forthcoming. [ABSTRACT FROM AUTHOR]

Among types of 3D printing, fused deposition modeling (FDM) and digital light processing (DLP) are the most accessible, making them attractive, low-cost options for simulating surgical procedures. This study characterized and compared inexpensive, synthetic temporal bone models printed using Resin, PETG, and Simubone™. This study compared models made of polyethylene terephthalate glycol (PETG), Simubone™ produced from a FDM printer, and photopolymer resin from a DLP printer. These temporal bone models were processed by: (1) DICOM files from a patient's CT scan were segmented to define critical parts expected in a temporal bone surgery. (2) The model was appended with a base that articulates with a 3D-printed temporal bone holder. (3) The refined, patient-specific model was manufactured using FDM and DLP printing technologies. (4) The models were sent to evaluators, who assessed the models based on anatomic accuracy, dissection experience, and its applicability as a surgical simulation tool for temporal bone dissection. The photopolymer resin outperformed PETG and Simubone™ in terms of anatomical accuracy and dissection experience. Additionally, resin and PETG were evaluated to be appropriate for simple mastoidectomy and canal wall down mastoidectomy while Simubone™ was only suitable for simple mastoidectomy. All models were unsuitable for posterior tympanotomy and labyrinthectomy. Photopolymer resin and PETG have shown to be suitable materials for dissection models with 3D-printed resin models showing more accuracy in replicating anatomical structures and dissection experience. Hence, the use of 3D-printed temporal bones may be a suitable low-cost alternative to cadaveric dissection. [ABSTRACT FROM AUTHOR]

Background: The spatial accuracy of microsurgical manipulations is one of the critical factors in successful surgical interventions. The purpose of this study was to create a low-cost, high-fidelity, and easy-to-use simulator for microsurgical skills training, which can be made by residents themselves at home. Methods: In response to the COVID-19 pandemic, we created a device for spatial accuracy microsurgical skills training and implemented it in our resident's training program. We propose a design for basic and advanced models. The simulator consisted of commonly available products. Results: A low-cost, durable, and high-fidelity basic model has been developed at a total cost of <10 dollars per unit. The model allows trainees to practice the critical microsurgical skills of tool targeting in a home-based setting. Conclusion: The developed device can be assembled at an affordable price using commercially available materials. Such simulation models can provide valuable training opportunities for microsurgery residents. [ABSTRACT FROM AUTHOR]

Objective: Simulation may be a valuable tool in training laryngology office procedures on unsedated patients. However, no studies have examined whether existing awake procedure simulators improve trainee performance in laryngology. Our objective was to evaluate the transfer validity of a previously published 3D‐printed laryngeal simulator in improving percutaneous injection laryngoplasty (PIL) competency compared with conventional educational materials with a single‐blinded randomized controlled trial. Methods: Otolaryngology residents with fewer than 10 PIL procedures in their case logs were recruited. A pretraining survey was administered to participants to evaluate baseline procedure‐specific knowledge and confidence. The participants underwent block randomization by postgraduate year to receive conventional educational materials either with or without additional training with a 3D‐printed laryngeal simulator. Participants performed PIL on an anatomically distinct laryngeal model via trans‐thyrohyoid and trans‐cricothyroid approaches. Endoscopic and external performance recordings were de‐identified and evaluated by two blinded laryngologists using an objective structured assessment of technical skill scale and PIL‐specific checklist. Results: Twenty residents completed testing. Baseline characteristics demonstrate no significant differences in confidence level or PIL experience between groups. Senior residents receiving simulator training had significantly better respect for tissue during the trans‐thyrohyoid approach compared with control (p < 0.0005). There were no significant differences in performance for junior residents. Conclusions: In this first transfer validity study of a simulator for office awake procedure in laryngology, we found that a previously described low‐cost, high‐fidelity 3D‐printed PIL simulator improved performance of PIL amongst senior otolaryngology residents, suggesting this accessible model may be a valuable educational adjunct for advanced trainees to practice PIL. Level of Evidence: NA Laryngoscope, 134:318–323, 2024 [ABSTRACT FROM AUTHOR]

IntroductionSurgical education is undergoing a transformation, moving away from traditional models towards more modern approaches that integrate experiential and didactic methods. This shift is particularly pertinent in the realm of fetal and neonatal surgery, where specialized training is crucial. Historical training methods, such as cadaveric dissection, have been prevalent for centuries, but newer innovations, including animal and non-animal simulation models, are gaining prominence. This manuscript aims to explore the use of both animal and non-animal models in surgical education, with a specific focus on fetal and neonatal surgery.Animal modelsThe use of animal models in surgical training has a long history, dating back to Halsted's introduction in 1889. These models, often utilizing large animals like swine and dogs, offer valuable insights into fetal and neonatal surgeries. They allow for the study of long-term outcomes and the simulation of various diseases and anomalies, providing essential training experiences not readily available in human surgeries. However, there are notable limitations, including anatomical and physiological differences from humans, ethical considerations, and substantial infrastructure and maintenance costs.Simulation modelsSimulation-based training offers several benefits, including standardized and safe learning environments without risks to real patients. Bench models, using synthetic materials or non-living animal tissue, provide cost-effective options for skills development. Virtual reality and 3-D printing technologies further enhance simulation experiences, allowing for the replication of complex clinical scenarios and patient-specific anatomies. While these models offer significant advantages, they lack the complexity of biological systems found in animal models.ConclusionIn conclusion, both animal and non-animal simulation models play crucial roles in enhancing surgical education, particularly in fetal and neonatal surgery. While advancements in non-animal technologies are important for ethical reasons, the continued necessity of animal models in certain areas should be acknowledged. By responsibly integrating these models into training programs, surgical education can be further enriched while upholding ethical standards and ensuring optimal patient outcomes.

Introduction As surgical technologies grow, so too do demands on surgical trainees to master increasing numbers of skill sets. With the rise of endovascular surgery, trainees have fewer opportunities to practice open vascular techniques in the operating room. Simulation can bridge this gap. However, existing published open vascular simulation curricula are basic or based on expensive models. Methods We iteratively developed an open vascular skills curriculum for second-year surgery residents comprising six 2-hour sessions. We refined the curriculum based on feedback from learners and faculty. The curriculum required skilled facilitators, vascular instruments, and tissue models. We evaluated the latest iteration with a survey and by assessing participants’ technical skills using the Objective Structured Assessment of Technical Skills (OSATS) form. Results Over the past 10 years, 101 residents have participated in the curriculum. Nine of 13 residents who participated in the latest curricular iteration completed the survey. All respondents rated the sessions as excellent and strongly agreed that they had improved their abilities to perform anastomoses with tissue and prosthetic. Facilitators completed 18 OSATS forms for residents in the fifth and sixth sessions of the latest iteration. Residents scored well overall, with a median 26.5 (interquartile range: 24–29) out of a possible score of 35, with highest scores on knowledge of instruments. Discussion This simulation-based curriculum facilitates open vascular surgical skill acquisition among surgery residents. The curriculum allows residents to acquire critical vascular skills that are challenging to learn in an increasingly demanding operative setting.

ObjectiveTo assess the impact of automated algorithms on the trainees’ decision-making capacity and confidence for individualized surgical planning.MethodsAt Chinese PLA General Hospital, trainees were enrolled to undergo decision-making capacity and confidence training through three alternative visual tasks of the inferior clivus model formed from an automated algorithm and given consecutively in three exemplars. The rationale of automated decision-making was used to instruct each trainee.ResultsFollowing automated decision-making calculation in 50 skull base models, we screened out three optimal plans, infra-tubercle approach (ITA), trans-tubercle approach (TTA), and supra-tubercle approach (STA) for 41 (82.00%), 8 (16.00%), and 1 (2.00%) subject, respectively. From September 1, 2023, through November 17, 2023, 62 trainees (median age [range]: 27 [26–28]; 28 [45.16%] female; 25 [40.32%] neurosurgeons) made a decision among the three plans for the three typical models (ITA, TTA, and STA exemplars). The confidence ratings had fine test-retest reliability (Spearman's rho: 0.979; 95% CI: 0.970 to 0.988) and criterion validity with time spent (Spearman's rho: −0.954; 95%CI: −0.963 to −0.945). Following instruction of automated decision-making, time spent (initial test: 24.02 vs. 7.13 in ITA; 30.24 vs. 7.06 in TTA; 34.21 vs. 12.82 in STA) and total hits (initial test: 30 vs. 16 in ITA; 37 vs. 17 in TTA; 42 vs. 28 in STA) reduced significantly; confidence ratings (initial test: 2 vs. 4 in ITA; 2 vs. 4 in TTA; 1 vs. 3 in STA) increased correspondingly. Statistically significant differences (P

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Abstract Objectives Exoscopes represent a promising alternative to conventional binocular microscopes (OM) in otology offering potential advantages such as enhanced ergonomics and a more compact device design. While previous research has demonstrated the effectiveness of exoscopes in various surgical specialties, their objective assessment in the field of otology remains limited. Therefore, this investigation aims to assess task‐based efficiency associated with exoscopes in the field of otology by use of simulated surgical models. Methods A prospective cross‐over study design was used to compare an OM to an exoscope in otolaryngology residents and medical students. Participants performed five tasks on 3D‐printed ear models using both the exoscope and OM. Data collection included completion time, frequency of predefined errors, mental effort, and user experience. Subgroup analysis was performed based on level of experience. Results Fourteen students and fifteen residents participated. Participants completed four of five tasks faster with the OM and there was no difference in number of errors committed. When separated by surgical experience, residents performed four of five tasks faster using the OM while students completed one of five tasks faster with the OM. Students committed more errors with the exoscope for one task with no difference in errors for residents. There was no difference in perceived difficulty performing tasks with either visualization system. Exit survey results showed more favorable opinions of the OM among residents and more favorable opinions of the exoscope among students. Conclusions The exoscope permits successful performance in simulated otologic tasks. Task performance and user experience between operative microscopes and exoscopes differ based on level of surgical experience. Level of Evidence 2.

The use of 3D-printed models in simulation-based training and planning for vascular surgery is gaining interest. This study aims to provide an overview of the current applications of 3D-printing technologies in vascular surgery. We performed a systematic review by searching four databases: PubMed, Web of Science, Scopus, and Cochrane Library (last search: 1 March 2024). We included studies considering the treatment of vascular stenotic/occlusive or aneurysmal diseases. We included papers that reported the outcome of applications of 3D-printed models, excluding case reports or very limited case series (≤5 printed models or tests/simulations). Finally, 22 studies were included and analyzed. Computed tomography angiography (CTA) was the primary diagnostic method used to obtain the images serving as the basis for generating the 3D-printed models. Processing the CTA data involved the use of medical imaging software; 3DSlicer (Brigham and Women’s Hospital, Harvard University, Boston, MA), ITK-Snap, and Mimics (Materialise NV, Leuven, Belgium) were the most frequently used. Autodesk Meshmixer (San Francisco, CA, USA) and 3-matic (Materialise NV, Leuven, Belgium) were the most frequently employed mesh-editing software during the post-processing phase. PolyJet™, fused deposition modeling (FDM), and stereolithography (SLA) were the most frequently employed 3D-printing technologies. Planning and training with 3D-printed models seem to enhance physicians’ confidence and performance levels by up to 40% and lead to a reduction in the procedure time and contrast volume usage to varying extents.

Virtual planning has revolutionized orthognathic surgery (OGS), marking a significant advancement in the field. This study aims to showcase the practical application of our established 3D average skull template as a guiding framework for surgical planning, and to share valuable insights from our clinical experience. We enrolled 30 consecutive Taiwanese patients (18 females and 12 males) who underwent two-jaw orthognathic surgery with surgical simulation, utilizing the average skull template for planning. Results indicate the method's applicability and precision. By adhering to the surgical plan, post-operative outcomes closely aligned with the average skull template, showing negligible deviations of less than 2 mm. Moreover, patients expressed high satisfaction with post-surgery facial changes, with the chin appearance receiving the highest satisfaction scores, while the lowest scores were attributed to nose appearance. Notably, the substantial change in lower jaw position post-mandibular setback surgery contributed to increased satisfaction with the chin position. In conclusion, this study does not seek to replace established surgical planning methods, but underscores that utilizing an average skull as a surgical design template provides a viable, accurate, and efficient option for OGS patients. [ABSTRACT FROM AUTHOR]

Oral cavity defects occur after resection of lesions limited to the mucosa, alveolar gum, or minimally affecting the bone. Aiming at esthetical and functional improvements of intraoral reconstruction, the possibility of harvesting a new galeo-pericranial free flap was explored. The objective of this study was to assess the technical feasibility of flap harvesting through anatomical dissections and surgical procedure simulations. Ten head and neck specimens were dissected to simulate the surgical technique and evaluate the vascular calibers of temporal and cervical vessels. The procedure was therefore reproduced on a revascularized and ventilated donor cadaver. Anatomical dissections demonstrated that the mean cervical vascular calibers are compatible with superficial temporal ones, proving to be adequate for anastomosis. Perforating branches of the superficial temporal vascularization nourishing the pericranium were identified in all specimens. In conclusion, blood flow presence was recorded after anastomosing superficial temporal and facial vessels in the revascularized donor cadaver, demonstrating both this procedure's technical feasibility and the potential revascularization of the flap and therefore encouraging its potential in vivo application. [ABSTRACT FROM AUTHOR]