• Jiwook Ryu, Seok Keun Choi, Yeongu Chung, Sung Ho Lee, and Bi-O Jeong.
• Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
• World Neurosurg. 2017 Nov 1; 107: 263-267.

IntroductionDeep bypass surgery remains a challenging operative procedure. For novice trainees, there is a high barrier to improving the microsurgical skills needed for this procedure because of the relatively low number of cases and the high cost of microsurgical instruments. Here, the authors introduce a training model that includes highly accessible devices and does not require a microscope.Materials And MethodsThe surgical environment consisted of two 15.5-cm straight serrated forceps with a 1-mm tip width (Medicon, Tuttlingen, Germany), 9-cm curved iris scissors (Medicon), 4-0 black silk suture, gauze, and a 15 × 10.5 × 3.5-cm-sized box with a transparent cover. These materials are affordable even in low-income countries.ProcedureTo understand and learn the hand positioning used in the deep surgical field, suturing practice was performed as follows: the forceps and a needle were placed in a slanted position, with hand position maintained at a 50° angle between the 2 forceps. This was also performed above the desk, without wrist support.ConclusionsOur training system will be helpful, especially for deep bypass surgery, since training with similar muscle effort and fatigue can improve surgical skills. This system is economic, highly accessible, and available even for portable training.Copyright © 2017 Elsevier Inc. All rights reserved.

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