{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:20:08Z","timestamp":1789842008100,"version":"4.0.1"},"reference-count":44,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nThe main objectives of this paper are to outline the essential tools, instruments, and equipment needed to set up a functional microsurgery laboratory that is affordable for low-income hospitals and to identify cost-effective alternatives for acquiring microsurgical equipment, such as refurbished or donated instruments, collaborating with medical device manufacturers for discounted rates, or exploring local suppliers.<\/jats:p>\n<\/jats:sec>\n\nMethods: <\/jats:title>\nStep-by-step instructions were provided on setting up the microsurgery laboratory, including recommendations for the layout, ergonomic considerations, lighting, and sterilization processes while ensuring cost-effectiveness, as well as comprehensive training protocols and a curriculum specifically tailored to enhance microsurgical skills in neurosurgery residents.<\/jats:p>\n<\/jats:sec>\n\nResults: <\/jats:title>\nWe explored cost-effective options for obtaining microsurgery simulators and utilizing open-source or low-cost virtual training platforms. We also included guidelines for regular equipment maintenance, instrument sterilization, and establishing protocols for infection control to ensure a safe and hygienic learning environment. To foster collaboration between low-income hospitals and external organizations or institutions that can provide support, resources, or mentorship, this paper shows strategies for networking, knowledge exchange, and establishing partnerships to enhance microsurgical training opportunities further. We evaluated the impact and effectiveness of the low-cost microsurgery laboratory by assessing the impact and effectiveness of the established microsurgery laboratory in improving the microsurgical skills of neurosurgery residents. About microsutures and microanastomosis, after three weeks of training, residents showed improvement in \u201csurgical time\u201d for ten separate simple stitches (30.06 vs. 8.65 min) and ten continuous single stitches (19.84 vs. 6.51 min). Similarly, there was an increase in the \u201cgood quality\u201d of the stitches and the suture pattern from 36.36% to 63.63%.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nBy achieving these objectives, this guide aims to empower low-income hospitals and neurosurgery residents with the necessary resources and knowledge to establish and operate an affordable microsurgery laboratory, ultimately enhancing the quality of microsurgical training and patient care in low-income countries.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_791_2023","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T11:12:27Z","timestamp":1703243547000},"page":"437","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Enhancing microsurgical skills in neurosurgery residents of low-income countries: A comprehensive guide"],"prefix":"10.25259","volume":"14","author":[{"given":"Carlos Salvador Ovalle","family":"Torres","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, National University of Mexico Hospital General, Durango,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo Espinosa","family":"Mora","sequence":"additional","affiliation":[{"name":"Neurosurgery Service, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Campero","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, San Miguel de Tucuman, Argentina,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iype","family":"Cherian","sequence":"additional","affiliation":[{"name":"Institute of Neurosciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Sufianov","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Federal Center of Neurosurgery, Tyumen,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar Fragoza","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National University of Mexico Hospital General, Durango,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel Encarnacion","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Peoples\u2019 Friendship University of Russia, Moscow, Russian Federation,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issael Ramirez","family":"Pena","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renat","family":"Nurmukhametov","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, RUDN University, Moscow, Russian Federation,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macario Arellano","family":"Beltr\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National University of Mexico Hospital General, Durango,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo Diaz","family":"Juarez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National University of Mexico Hospital General, Durango,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo Mu\u00f1oz","family":"Cobos","sequence":"additional","affiliation":[{"name":"Neurosurgery Service, Hospital Star Medica, Chihuahua, Mexico,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"Lafuente-Baraza","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Department of Neurosurgery, Hospital del Mar, Barcelona, Spain,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matias","family":"Baldoncini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, San Fernando Hospital, Belgrano, San Fernando, Argentina,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabino","family":"Luzzi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pavia, Pavia,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Montemurro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2023,12,22]]},"reference":[{"key":"10.25259\/SNI_791_2023\/ref-1","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.3390\/jpm13071044","article-title":"Randomized clinical trials and observational tribulations: Providing clinical evidence for personalized surgical pain management care models","volume":"13","author":"Abraham","year":"2023","journal-title":"J Pers Med"},{"key":"10.25259\/SNI_791_2023\/ref-2","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4103\/0976-3147.131660","article-title":"Microsurgical training model for residents to approach to the orbit and the optic nerve in fresh cadaveric sheep cranium","volume":"5","author":"Altunrende","year":"2014","journal-title":"J Neurosci Rural Pract"},{"key":"10.25259\/SNI_791_2023\/ref-3","first-page":"1","article-title":"Global neurosurgery: A retrospective cohort study to compare the effectiveness of two training methods in resource-poor settings","volume":"4","author":"Attebery","year":"2023","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_791_2023\/ref-4","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.wneu.2019.04.139","article-title":"Microsurgical anatomy and approaches to the cerebral central core","volume":"129","author":"Baldoncini","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-5","first-page":"84","article-title":"Microsurgery guide on training techniques in minimally invasive surgery","volume":"33","author":"Camacho Garc\u00eda","year":"2019","journal-title":"Rev Colombi Ortop Traumatol"},{"key":"10.25259\/SNI_791_2023\/ref-6","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4103\/1793-5482.121684","article-title":"Cisternostomy: Replacing the age old decompressive hemicraniectomy?","volume":"8","author":"Cherian","year":"2013","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-7","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.wneu.2017.05.174","article-title":"An affordable microsurgical training system for a beginning neurosurgeon: How to realize the self-training laboratory","volume":"105","author":"Chung","year":"2017","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-8","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1080\/2000656X.2021.1953043","article-title":"Effectiveness of a microsurgery training program using a chicken wing model","volume":"56","author":"Dave","year":"2022","journal-title":"J Plast Surg Hand Surg"},{"key":"10.25259\/SNI_791_2023\/ref-9","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.wneu.2022.03.144","article-title":"Development of a novel low-cost exoscope to expand access to microneurosurgical care in low-and middle-income countries","volume":"163","author":"De Jesus Encarnacion Ramirez","year":"2022","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-10","doi-asserted-by":"crossref","first-page":"664","DOI":"10.3390\/neurolint14030054","article-title":"Anatomical variations of the median nerve: A cadaveric study","volume":"14","author":"Encarnacion","year":"2022","journal-title":"Neurol Int"},{"key":"10.25259\/SNI_791_2023\/ref-11","doi-asserted-by":"crossref","first-page":"1055189","DOI":"10.3389\/fmedt.2022.1055189","article-title":"Comparative survey study of the use of a low cost exoscope vs. microscope for anterior cervical discectomy and fusion (ACDF)","volume":"4","author":"Encarnacion Ramirez","year":"2022","journal-title":"Front Med Technol"},{"key":"10.25259\/SNI_791_2023\/ref-12","doi-asserted-by":"crossref","first-page":"330","DOI":"10.3390\/biomedicines11020330","article-title":"Development of a 3D printed brain model with vasculature for neurosurgical procedure visualisation and training","volume":"11","author":"Encarnacion Ramirez","year":"2023","journal-title":"Biomedicines"},{"key":"10.25259\/SNI_791_2023\/ref-13","first-page":"1","article-title":"Three-dimensional cerebrovascular bypass training. A new low-cost home-made model","volume":"2","author":"Encarnacion Ramirez","year":"2021","journal-title":"Front Med Case Rep"},{"key":"10.25259\/SNI_791_2023\/ref-14","doi-asserted-by":"crossref","first-page":"560","DOI":"10.3390\/bioengineering10050560","article-title":"Analysis of the robotic-based in situ bioprinting workflow for the regeneration of damaged tissues through a case study","volume":"10","author":"Fortunato","year":"2023","journal-title":"Bioengineering (Basel)"},{"key":"10.25259\/SNI_791_2023\/ref-15","first-page":"160","article-title":"Development of microsurgical techniques using vascular staining with and without silicone in human placenta with 3D cranial models","volume":"35","author":"G\u00f3mez-Vega","year":"2021","journal-title":"Rev Argent Neuroc"},{"key":"10.25259\/SNI_791_2023\/ref-16","doi-asserted-by":"crossref","first-page":"97","DOI":"10.9734\/jammr\/2021\/v33i230812","article-title":"Microsurgery training: Are the live models era coming in to the tail?-a literature review","volume":"33","author":"Hosain","year":"2021","journal-title":"J Adv Med Med Res"},{"key":"10.25259\/SNI_791_2023\/ref-17","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1097\/BRS.0000000000004339","article-title":"Appropriate telemedicine utilization in spine surgery: Results from a Delphi study","volume":"47","author":"Iyer","year":"2022","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/SNI_791_2023\/ref-18","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1002\/micr.30513","article-title":"Current status of simulation and training models in microsurgery: A systematic review","volume":"39","author":"Javid","year":"2019","journal-title":"Microsurgery"},{"key":"10.25259\/SNI_791_2023\/ref-19","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s10143-023-01995-5","article-title":"Simulation training approaches in intracranial aneurysm surgery-a systematic review","volume":"46","author":"Joseph","year":"2023","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_791_2023\/ref-20","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1186\/s12909-021-02737-1","article-title":"Microsurgical training course for clinicians and scientists: A 10-year experience at the M\u00fcnster university hospital","volume":"21","author":"Juratli","year":"2021","journal-title":"BMC Med Educ"},{"key":"10.25259\/SNI_791_2023\/ref-21","doi-asserted-by":"crossref","first-page":"852","DOI":"10.3390\/jpm13050852","article-title":"The changing environment in postgraduate education in orthopedic surgery and neurosurgery and its impact on technology-driven targeted interventional and surgical pain management: Perspectives from Europe, Latin America, Asia, and the United States","volume":"13","author":"Lewandrowski","year":"2023","journal-title":"J Pers Med"},{"key":"10.25259\/SNI_791_2023\/ref-22","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.3171\/2014.11.JNS14902","article-title":"Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training","volume":"123","author":"Liu","year":"2015","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-23","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1080\/02688697.2021.1935732","article-title":"From textbook to patient: A practical guide to train the end-to-side microvascular anastomosis","volume":"37","author":"Lizana","year":"2023","journal-title":"Br J Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-24","first-page":"e43192","article-title":"Role of artificial intelligence in global surgery: A review of opportunities and challenges","volume":"15","author":"Malhotra","year":"2023","journal-title":"Cureus"},{"key":"10.25259\/SNI_791_2023\/ref-25","first-page":"101400","article-title":"Microsurgical training through laboratory experience: A step-by-step practical guideline","volume":"7","author":"Marian-Maga\u00f1a","year":"2022","journal-title":"Interdicip Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-26","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1590\/S0102-86502007000100014","article-title":"Basic microsurgery training: Comments and proposal","volume":"22","author":"Martins","year":"2007","journal-title":"Acta Cir Bras"},{"key":"10.25259\/SNI_791_2023\/ref-27","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.3171\/2017.7.JNS17517","article-title":"The microneurosurgical anatomy legacy of Albert L. Rhoton Jr MD: An analysis of transition and evolution over 50 years","volume":"129","author":"Matsushima","year":"2018","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-28","doi-asserted-by":"crossref","first-page":"8799","DOI":"10.3390\/ijerph19148799","article-title":"New targets and new technologies in the treatment of Parkinson\u2019s disease: A narrative review","volume":"19","author":"Montemurro","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"10.25259\/SNI_791_2023\/ref-29","doi-asserted-by":"crossref","first-page":"6347","DOI":"10.3390\/ijerph19106347","article-title":"Brain tumor and augmented reality: New technologies for the future","volume":"19","author":"Montemurro","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"10.25259\/SNI_791_2023\/ref-30","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3390\/jcm11010223","article-title":"The exoscope in neurosurgery: An overview of the current literature of intraoperative use in brain and spine surgery","volume":"11","author":"Montemurro","year":"2021","journal-title":"J Clin Med"},{"key":"10.25259\/SNI_791_2023\/ref-31","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1177\/21925682221090891","article-title":"Telemedicine: Could it represent a new problem for spine surgeons to solve?","volume":"12","author":"Montemurro","year":"2022","journal-title":"Global Spine J"},{"key":"10.25259\/SNI_791_2023\/ref-32","first-page":"15","article-title":"Manual pr\u00e1ctico de microcirug\u00eda cirug\u00eda vascular y nerviosa","volume":"1","author":"Mu\u00f1oz Cobos","year":"2017","edition":"1st ed"},{"key":"10.25259\/SNI_791_2023\/ref-33","first-page":"22","article-title":"Techniques for the anatomical study of the brain: A review","volume":"62","author":"Ocampo-Navia","year":"2021","journal-title":"Univ Med"},{"key":"10.25259\/SNI_791_2023\/ref-34","first-page":"1","article-title":"Surgical approaches to cavernous sinus: A narrative review of the literature with anatomical drawings","volume":"30","author":"Pahwa","year":"2022","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-35","doi-asserted-by":"crossref","first-page":"300","DOI":"10.59156\/revista.v34i04.149","article-title":"Comprehensive microsurgical and neuroendovascular training model with human placenta","volume":"34","author":"P\u00e9rez-Zabala","year":"2020","journal-title":"Rev Argent Neuroc"},{"key":"10.25259\/SNI_791_2023\/ref-36","doi-asserted-by":"crossref","first-page":"100815","DOI":"10.1016\/j.bas.2021.100815","article-title":"Training in cerebral aneurysm clipping using self-made 3-dimensional models including blood flow","volume":"1","author":"Ramirez","year":"2021","journal-title":"Brain Spine"},{"key":"10.25259\/SNI_791_2023\/ref-37","first-page":"e27472","article-title":"Three-dimensional plastic modeling on bone frames for cost-effective neuroanatomy teaching","volume":"14","author":"Ramirez","year":"2022","journal-title":"Cureus"},{"key":"10.25259\/SNI_791_2023\/ref-38","doi-asserted-by":"crossref","first-page":"894","DOI":"10.3390\/neurolint14040072","article-title":"Anatomical variations of the sciatic nerve exit from the pelvis and its relationship with the piriformis muscle: A cadaveric study","volume":"14","author":"Reynoso","year":"2022","journal-title":"Neurol Int"},{"key":"10.25259\/SNI_791_2023\/ref-39","first-page":"10","article-title":"Manual de microcirugia neurovascular","volume":"1","author":"Sampr\u00f3nf","year":"2017","edition":"1st ed"},{"key":"10.25259\/SNI_791_2023\/ref-40","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1007\/s13304-023-01613-5","article-title":"How future surgery will benefit from SARS-COV-2-related measures: A SPIGC survey conveying the perspective of Italian surgeons","volume":"75","author":"Siragusa","year":"2023","journal-title":"Updates Surg"},{"key":"10.25259\/SNI_791_2023\/ref-41","doi-asserted-by":"crossref","first-page":"894","DOI":"10.3390\/brainsci13060894","article-title":"The use of 3D printed models for surgical simulation of cranioplasty in craniosynostosis as training and education","volume":"13","author":"Uhl","year":"2023","journal-title":"Brain Sci"},{"key":"10.25259\/SNI_791_2023\/ref-42","doi-asserted-by":"crossref","first-page":"E229","DOI":"10.1093\/neuros\/nyab252","article-title":"Rhoton Society, Evandro Pinto da Luz de Oliveira, MD, PhD (November 8, 1945-February 11, 2021): A giant of microneurosurgery and neuroanatomy","volume":"89","author":"Wen","year":"2021","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_791_2023\/ref-43","first-page":"146","article-title":"Microneurosurgical skills training","volume":"77","author":"Yadav","year":"2016","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"10.25259\/SNI_791_2023\/ref-44","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1097\/00006123-199911000-00014","article-title":"A legacy of microneurosurgery: Memoirs, lessons, and axioms","volume":"45","author":"Ya\u015fargil","year":"1999","journal-title":"Neurosurgery"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/enhancing-microsurgical-skills-in-neurosurgery-residents-of-low-income-countries-a-comprehensive-guide\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/enhancing-microsurgical-skills-in-neurosurgery-residents-of-low-income-countries-a-comprehensive-guide\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T11:13:10Z","timestamp":1703243590000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/enhancing-microsurgical-skills-in-neurosurgery-residents-of-low-income-countries-a-comprehensive-guide\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,22]]},"references-count":44,"alternative-id":["10.25259\/SNI_791_2023"],"URL":"https:\/\/doi.org\/10.25259\/sni_791_2023","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2023,12,22]]},"article-number":"437"}}