2026 Proffered Presentations
S164: THE NO-COST HANDS-ON BASIC MICROVASCULAR ANASTOMOSIS SLINGSHOT PROGRAM: A FIRST-IN-HISTORY GLOBAL MODEL FOR SUSTAINABLE MICROSURGICAL TRAINING IN LMICS
Abdullah Keles, MD1; Yannick C Kessely, MD2; Zviad Malazonia, MD3; Turab A Gasimov, MD4; Abdurrahman Aycan, MD5; Robert J Dempsey, MD1; Mustafa K Baskaya, MD1; 1Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; 2Department of Surgery, Hospital de la Renaissance, N'Djamena, Chad; 3Department of Neurological Surgery, Caucasus Medical Center, Tbilisi, Georgia; 4Department of Neurosurgery, Hegau Bodensee Klinikum Singen, Singen, Germany; 5Department of Neurological Surgery, Van Yuzuncu Yil University School of Medicine, Van, Türkiye
Background: In low- and middle-income countries (LMICs), limited resources, lack of experts, and absence of laboratory infrastructure have restricted access to essential microsurgical training. Although short-term workshops provide valuable exposure, the lack of infrastructure for continued practice has historically prevented long-lasting impact. To address this gap, the no-cost Slingshot Program was developed to deliver basic hands-on microvascular anastomosis training while simultaneously equipping host centers with resources required for sustainable practice.
Objective: To evaluate the feasibility, global reach, and sustainability of the Slingshot Program as a novel model for hands-on microsurgical training in LMICs.
Methods: Between January 2023 and April 2025, 16 Slingshot Programs were organized in seven countries—Turkey, Georgia, Azerbaijan, Paraguay, Mexico, the Democratic Republic of Congo, and the United States. Each program included structured didactic instruction, live microvascular anastomosis demonstrations, and supervised hands-on practice using basic microsurgery training kits (Figure 1).
Figure 1. (A) Basic microsurgery training kits, (B) demonstration microscope (C) didactics, and (D) live demonstration.
Participants were selected exclusively from LMICs to ensure equitable access. Programs were delivered in 1-, 2-, or 3-day formats and featured stepwise practice using Penrose drains, silicone tubes, chicken vessels, and live rat vessels (Figure 2).
Figure 2. Hands-on practice sessions. (A) Penrose drain practice with 6-0/7-0, (B) silicone tube practice with 9-0, (C) chicken vessel practice with 9-0/10-0, and (D) live rat vessel practice with 10-0.
To ensure sustainability, 55 basic microsurgery training kits and practice materials were donated to host centers, accompanied by structured offline training modules and self-assessment tools to enable continued practice.
Results: A total of 302 participants from 33 countries, 75 cities, and 117 institutions completed the programs. Five surgical specialties were represented: neurosurgery, plastic surgery, general surgery, orthopedics, and cardiovascular surgery. In centers with residency programs, the donated basic microsurgery training kits and materials provided a foundation for continuous training, and several centers reported organizing follow-up sessions. Early clinical application was observed, with trainees successfully performing microvascular procedures (Figure 3).
Figure 3. Trainee practice and clinical application. Dr. Zviad Malazonia form Tbilisi Georgia (A) practicing during 5th Slingshot Program (B) continuing independent practice using chicken vessels, (C) practicing using human placenta, and (D) performing a clinical extracranial–intracranial bypass case.
Participant feedback emphasized the accessibility, practicality, and sustainability of the program.
Discussion: The Slingshot Program uniquely bridges the gap between short-term exposure and long-term capacity-building by leaving behind microsurgery kits, training materials, and offline resources. This strategy ensures that skills acquired during the initial sessions are reinforced through continuous practice. To our knowledge, no prior initiative in the 70-year history of microsurgery has achieved this level of sustainable impact across multiple LMICs.
Conclusion: The Slingshot Program represents an unprecedented advancement in global neurosurgical education. By combining in-person hands-on instruction with donated training kits and offline resources, the program has trained more than 300 participants from 33 LMICs and created enduring opportunities for skill development at 117 institutions. This model democratizes access to microsurgical training and offers a scalable framework for advancing surgical capacity in resource-limited regions.