Expanding Access to Microsurgical Education: The Impact of Offline Training

Background: Microsurgery training in low- and middle-income countries (LMICs) is often hindered by a lack of infrastructure, resources, and reliable internet. To address these barriers, an innovative offline training program was developed, combining basic microsurgery kits, a structured microvascular anastomosis training curriculum, and self-assessment tools. Initially implemented in a centralized laboratory, this model ensures scalable and sustainable education without the need for expert evaluators or stable internet connections, providing accessible training opportunities in regions with limited resources. Objective: This study evaluates the effectiveness and impact of an offline training model in improving microsurgical skills, using data from a neurosurgery operative skills laboratory. It highlights the model's ability to provide self-directed, cost-effective, and reliable education. Methods: The program was initially implemented in a centralized laboratory, where 79 participants from countries such as Turkey, India, Nigeria, and Argentina completed the structured microvascular anastomosis training curriculum ([ Fig. 1 ]). Fig. 1 Microvascular anastomosis training curriculum. Trainees practiced microvascular anastomosis techniques using basic microsurgery kits ([ Fig. 2 ]). Fig. 2 ( A ) Basic microsurgery kit. ( B ) Trainee practice microvascular anastomosis techniques using basic microsurgery kit. They were provided a daily structured microvascular anastomosis training program with relevant books, pre-recorded curriculum training videos, and self-assessment videos to evaluate their exercises ([ Fig. 3 ]). Fig. 3 Structured microvascular anastomosis training curriculum. After the initial success, this offline training methodology was adapted for use in multiple LMIC centers. Feedback from trainees was collected to assess the accessibility, usability, and effectiveness of the offline resources, as well as the impact on skill improvement and clinical application. Results: The offline training program was successfully implemented with 79 trainees in a centralized laboratory, with all participants reporting significant improvements in their ability to practice independently. Some trainees successfully applied their skills to clinical procedures such as vascular bypasses, AV fistulas, and nerve repairs in their home countries ([ Fig. 4 ]). Fig. 4 The photos shared by our trainees show the results of their applied microsurgical techniques after completing offline training at our institution. Upon returning to their home countries, these trainees began using the skills they acquired to treat patients. ( A ) AV fistula case from Chad. ( B ) Nerve repair case from Türkiye. ( C ) Cerebral bypass case from India. ( D ) Cerebral bypass case from Georgia. The methodology is now being applied across multiple centers in LMICs, ensuring that even remote regions can access high-quality surgical training resources Discussion: The offline training model has proven to be scalable, cost-effective, and sustainable, offering a reliable solution for microsurgical education in LMICs. By combining self-assessment tools with offline resources, the program reduces dependency on expert evaluators and provides a self-directed learning experience. While challenges remain in addressing local resource variability, the continued expansion of the program demonstrates its potential for global scalability and long-term sustainability. Conclusion: The offline training program provides a viable solution to overcome the limitations of traditional training models in LMICs. By ensuring that microsurgical skills are accessible and sustainable, this program has the potential to enhance surgical capacity and improve clinical outcomes in underserved regions. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany