Microsurgical Anastomosis Rating Scale (MARS10): A Final Product Scoring System for Initial Microsurgical Training

Abstract

Background: High cost and ethical controversy of using living models in microsurgical training made non-living models more popular. However, non-living models don’t provide appropriate feedback of microsurgical performance. Currently existing Global Rating Scales used for advanced microsurgical skills validation are difficult to apply on non-living model. This study presents a simple instrument for basic assessment of microsurgical anastomosis on non-living model. Methods: Seventy medical students were divided into 2 groups depending on their prior microsurgical experience. Each participant performed 3 end-to-end anastomoses on chicken femoral artery model. Anastomoses were reviewed by 3 blinded experts and then photographed. Evaluation included a patency tests, longitudinal cut of anastomosis, and the newly proposed tool 10 Point Microsurgical Anastomosis Rating Scale (MARS10). Presented scale consists of 5 factors important for anastomosis closure (anastomosis closure, suture spacing, bites size, knot tying, and cut ends length), graded on 3 point scale (0-2 points). Results were analyzed with analysis of variance, Spearman correlation, and t Student test. Results: Anastomoses evaluated by experts as patent significantly correlated with a high summary score in MARS10 scale (r = 0.73 P < .0001). There was a significant difference in MARS10 score between groups (P < .0001). There were no significant inter-rater differences in scoring among all 3 evaluators (p > .05). Conclusions: 10 Point Microsurgical Anastomosis Rating Scale is a quick, valid, and reliable tool to assess microsurgical end-to-end arterial anastomoses on non-living model.