LETTER TO THE EDITOR
MICROSURGERY 00:00–00 (2014)
MICROSURGERY TRAINING USING A SMARTPHONE Dear Editor,
In a microsurgical procedure, adequate magnification of the operative field is essential. Magnifying loupes or an operating microscope is commonly used for this purpose. Although basic microsurgical training is essential in the orthopedic and plastic surgery residency program, buying an expensive personal loupes or using an operating microscope in every hospital for the purpose of resident training is not an easy matter. Smartphones, meanwhile, have impacted almost all sectors of human society, and are becoming ever more common tools for physicians.1 Our goal in this letter is to describe a microsurgical training program with a smartphone for beginners. We evaluated the usefulness of these smartphone functions for basic microsurgery training for beginners in microsurgery in the setting of ordinary table-top practice without personal loupes or an operating microscope. In our practice, we used two types of smartphones: the iPhone 5S (Apple Inc., Cupertino, CA) and Galaxy S4 (Samsung, Seoul, Korea) that use the representative operating systems of Apple’s iOS and Google’s Android, respectively. Microsurgical training was performed with first-time practitioners in microsurgery using 8-0 suture material for anastomosis of synthetic vessels of 2 mm and 4 mm diameters. Basic end-to-end anastomosis was performed and the operation field was magnified maximally by using the camera mode of each smartphone (Fig. 1). A special lighting application for continuous lighting during the practice was downloaded through the app store. To
*Correspondence to: Jong Woong Park, M.D., Korea University Anam Hospital, 78, Inchon-ro, Seongbuk-gu, Seoul, Korea 136-705. E-mail: ospark@ korea.ac.kr Published online 00 Month 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/micr.22369 Ó 2014 Wiley Periodicals, Inc.
hold the smartphone in a stable position, a commercially available smartphone holder was used. The smartphones were able to maximally enlarge the operation field to threefold (iPhone 5S) and fourfold (Galaxy S4) the actual size. The 8-0 suture material was not clearly visible to the naked eye; however, the images on the smartphone were clear enough to perform the anastomosis. The minimum auto-focusing distances of the iPhone 5S and Galaxy S4 were 10 cm and 6 cm, respectively. No differences according to operating system in the two smartphone models were evident in our study; however, the maximum magnification power and minimal auto-focusing distances of the two smartphones were different. All participants were satisfied with the quality of the image on the smartphones and responded that it was sufficient for them to practice microsurgical anastomosis. After their first practice session using the smartphone, trainees felt confident about their skill and were highly motivated to continue practicing. A well-equipped facility with a qualified training program is necessary to train beginners in microsurgery. However, the expense of operating microscopes, instruments, laboratory space, nonanimal or animal models, and animal care facilities are barriers to learning and teaching microsurgery. Furthermore, after completion of basic training, continued practice is usually impossible due to limited accessibility to facilities. Use of a smartphone to learn microsurgery addresses all of the above limitations. According to the recent studies, clinical applications of smartphone with its applications (apps) have been clarified their effectiveness in patient education with coronary artery disease,2 dermatologic diagnosis,3 accurate measurement of range of motion of the joints,4 and so on. In our practice, the instructors were able to see the operation field at the same time as the students, and were therefore able to provide real-time feedback during practice. Furthermore, the students were able to discuss about
2
Letter to the Editor JONG WOO KANG, M.D. Department of Orthopedic Surgery Korea University Ansan Hospital Ansan, Korea JAE KYUN KIM, M.D., Ph.D. Department of Orthopedic Surgery Korea University Ansan Hospital Ansan, Korea INCHAN YOUN, Ph.D. Biomedical Research Center Korea Institute of Science and Technology Seoul, Korea JONG WOONG PARK, M.D., Ph.D.* Department of Orthopedic Surgery Korea University Anam Hospital
Figure 1. Schematic drawing for smartphone setup to practice 2mm synthetic vessel anastomosis with 8-0 suture. A real image captured on the smartphone during the practice is superimposed on the drawing. Image quality and magnification is sufficient to perform anastomosis with 8-0 suture.
their own tasks after completion of the exercise through captured images and videos. This letter highlights the possibility of using a smartphone equipped with a high quality built-in camera to replace personal loupes or an operating microscope in basic microsurgery training. Accessibility and the lack of additional cost allow practitioners to continue practicing and continuously improve their skill through table-top exercises. DONG MIN KIM, M.D. Department of Orthopedic Surgery Korea University Anam Hospital Seoul, Korea
Microsurgery DOI 10.1002/micr
Seoul, Korea
REFERENCES 1. Barr C, Yao J. The use of smartphones in hand surgery. J Hand Surg Am 2012;37:168–170. 2. Cho MJ, Sim JL, Hwang SY. Development of smartphone educational application for patients with coronary artery disease. Healthc Inform Res 2014;20:117–124. 3. Ingraffea AA. Innovative use of a polarized magnifier and a smart phone: a microscope in your pocket. Dermatol Surg 2013;39:796. 4. Rwakabayiza S, Pereira LC, Lecureux E, Jolles-Haeberli B. Measurement of the knee range of motion: standard goniometer or smartphone? Rev Med Suisse 2013;9:2372–2375.
MICROSURGERY 00:00–00 (2014)
MICROSURGERY TRAINING USING A SMARTPHONE Dear Editor,
In a microsurgical procedure, adequate magnification of the operative field is essential. Magnifying loupes or an operating microscope is commonly used for this purpose. Although basic microsurgical training is essential in the orthopedic and plastic surgery residency program, buying an expensive personal loupes or using an operating microscope in every hospital for the purpose of resident training is not an easy matter. Smartphones, meanwhile, have impacted almost all sectors of human society, and are becoming ever more common tools for physicians.1 Our goal in this letter is to describe a microsurgical training program with a smartphone for beginners. We evaluated the usefulness of these smartphone functions for basic microsurgery training for beginners in microsurgery in the setting of ordinary table-top practice without personal loupes or an operating microscope. In our practice, we used two types of smartphones: the iPhone 5S (Apple Inc., Cupertino, CA) and Galaxy S4 (Samsung, Seoul, Korea) that use the representative operating systems of Apple’s iOS and Google’s Android, respectively. Microsurgical training was performed with first-time practitioners in microsurgery using 8-0 suture material for anastomosis of synthetic vessels of 2 mm and 4 mm diameters. Basic end-to-end anastomosis was performed and the operation field was magnified maximally by using the camera mode of each smartphone (Fig. 1). A special lighting application for continuous lighting during the practice was downloaded through the app store. To
*Correspondence to: Jong Woong Park, M.D., Korea University Anam Hospital, 78, Inchon-ro, Seongbuk-gu, Seoul, Korea 136-705. E-mail: ospark@ korea.ac.kr Published online 00 Month 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/micr.22369 Ó 2014 Wiley Periodicals, Inc.
hold the smartphone in a stable position, a commercially available smartphone holder was used. The smartphones were able to maximally enlarge the operation field to threefold (iPhone 5S) and fourfold (Galaxy S4) the actual size. The 8-0 suture material was not clearly visible to the naked eye; however, the images on the smartphone were clear enough to perform the anastomosis. The minimum auto-focusing distances of the iPhone 5S and Galaxy S4 were 10 cm and 6 cm, respectively. No differences according to operating system in the two smartphone models were evident in our study; however, the maximum magnification power and minimal auto-focusing distances of the two smartphones were different. All participants were satisfied with the quality of the image on the smartphones and responded that it was sufficient for them to practice microsurgical anastomosis. After their first practice session using the smartphone, trainees felt confident about their skill and were highly motivated to continue practicing. A well-equipped facility with a qualified training program is necessary to train beginners in microsurgery. However, the expense of operating microscopes, instruments, laboratory space, nonanimal or animal models, and animal care facilities are barriers to learning and teaching microsurgery. Furthermore, after completion of basic training, continued practice is usually impossible due to limited accessibility to facilities. Use of a smartphone to learn microsurgery addresses all of the above limitations. According to the recent studies, clinical applications of smartphone with its applications (apps) have been clarified their effectiveness in patient education with coronary artery disease,2 dermatologic diagnosis,3 accurate measurement of range of motion of the joints,4 and so on. In our practice, the instructors were able to see the operation field at the same time as the students, and were therefore able to provide real-time feedback during practice. Furthermore, the students were able to discuss about
2
Letter to the Editor JONG WOO KANG, M.D. Department of Orthopedic Surgery Korea University Ansan Hospital Ansan, Korea JAE KYUN KIM, M.D., Ph.D. Department of Orthopedic Surgery Korea University Ansan Hospital Ansan, Korea INCHAN YOUN, Ph.D. Biomedical Research Center Korea Institute of Science and Technology Seoul, Korea JONG WOONG PARK, M.D., Ph.D.* Department of Orthopedic Surgery Korea University Anam Hospital
Figure 1. Schematic drawing for smartphone setup to practice 2mm synthetic vessel anastomosis with 8-0 suture. A real image captured on the smartphone during the practice is superimposed on the drawing. Image quality and magnification is sufficient to perform anastomosis with 8-0 suture.
their own tasks after completion of the exercise through captured images and videos. This letter highlights the possibility of using a smartphone equipped with a high quality built-in camera to replace personal loupes or an operating microscope in basic microsurgery training. Accessibility and the lack of additional cost allow practitioners to continue practicing and continuously improve their skill through table-top exercises. DONG MIN KIM, M.D. Department of Orthopedic Surgery Korea University Anam Hospital Seoul, Korea
Microsurgery DOI 10.1002/micr
Seoul, Korea
REFERENCES 1. Barr C, Yao J. The use of smartphones in hand surgery. J Hand Surg Am 2012;37:168–170. 2. Cho MJ, Sim JL, Hwang SY. Development of smartphone educational application for patients with coronary artery disease. Healthc Inform Res 2014;20:117–124. 3. Ingraffea AA. Innovative use of a polarized magnifier and a smart phone: a microscope in your pocket. Dermatol Surg 2013;39:796. 4. Rwakabayiza S, Pereira LC, Lecureux E, Jolles-Haeberli B. Measurement of the knee range of motion: standard goniometer or smartphone? Rev Med Suisse 2013;9:2372–2375.
