The present training framework is reliable, feasible, repeatable and cost-effective. The skills competition can promote to improve the surgical skills level of trainees.

Anterior lumbar interbody fusion (ALIF) followed by posterior pedicle screw fixation (PSF) in a second procedure is mostly used to implement lumbar spine fusion. ALIF followed by anterior lumbar screw-plate has a lot of advantages, but its biomechanical stability requires confirmation. This study evaluated the biomechanical stability of a novel anterior lumbar locked screw-plate (ALLSP) by comparison with posterior lumbar PSF. Twelve fresh human cadaveric lumbar specimens (L4-L5) were assigned to four groups: ALIF+PSF group, ALIF+ALLSP (both fixed) group, ALIF group and an untreated control (both non-fixed) group. The first three groups received implantation of a rectangular titanium cage. Tests under axial compression, flexion, extension, lateral bending, or rotation showed that the fixed groups had significantly stronger stability than the non-fixed groups (P=0.000 for all). The ALIF+ALLSP group had significantly greater axial stiffness under applied axial compression and significantly less angular displacement under rotational forces than the ALIF+PSF group. The angular displacement of the ALIF+ALLSP group was less under flexion than that of the ALIF+PSF, and the angular displacement under lateral bending and extension was greater, but these differences were not statistically significant. In summary, the ALLSP conforms to the anterior lumbar spine and has good biomechanical stability. It is a reliable choice for enhancing the stability of ALIF.

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Background:Various anterior lumbar surgical approaches, including the minimally invasive approach, have greatly improved in recent years. Vascular complications resulting from ALIF are frequently reported. Little information is available about the safety of large blood vessel stretch. We evaluated the right side stretch limit (RSSL) of the abdominal aorta (AAA) and the inferior vena cava (IVC) without blood flow occlusion and investigated stretch-induced histological injury and thrombosis in the iliac and femoral arteries and veins and the stretched vessels.Materials and Methods:The RSSL of blood vessels in five adult goats was measured by counting the number of 0.5-cm-thick wood slabs that were inserted between the right lumbar edge and the stretch hook. Twenty seven adult goats were divided into three groups to investigate histological injury and thrombosis under a stretch to 0.5 cm (group I) 1.5 cm (group II) for 2 h, or no stretch (group III). Blood vessel samples from groups I and II were analyzed on postsurgical days 1, 3, and 7. Thrombogenesis was examined in the iliac and femoral arteries and veins.Results:The RSSL of large blood vessels in front of L4/5 was 1.5 cm from the right lumbar edge. All goats survived surgery without complications. No injury or thrombosis in the large blood vessels in front of the lumbar vertebrae and in the iliac or femoral arteries and veins was observed. Under light microscopy, group I showed slight swelling of endothelial cells in the AAA and no histological injury of the IVC. The AAA of group II showed endothelial cell damage, unclear organelles, and incomplete cell connections by electron microscopy.Conclusions:The AAA and IVC in a goat model can be stretched by ≤0.5 cm, with no thrombosis in the AAA, IVC, iliac or femoral arteries and veins.

Microsurgical techniques are becoming more and more important to modern surgery. Microsurgery constitutes the basis of many surgical specialties, such as hand surgery, transplantation surgery, plastic surgery, and neurosurgery, among others. To an increasing extent, junior surgeons need to acquire microsurgical skills to pursue their surgical careers. However, factors such as law, time, and cost can limit the opportunity for or access to microsurgical skills training. Ilie and Chan et al 1,2 conducted a review of the literature, summed up several nonliving training models, and pointed out that none of the models are sufficiently integrative. An optimal model closely simulates real-life conditions so as to facilitate skills transfer, and it is also cost-effective.In this context, we explored the waste intercostal neurovascular bundles of common adult dogs to be used for microsurgical skills training. These dog "spare ribs" came from common dogs that had been used for other scientific research without biohazard and that had to be sacrificed because of specimen collection (Animal protection approval was granted by the Institutional Animal Care Committee). It was attempted to convert the waste into an optimal training resource to reduce expenditure and to reduce the number of animals used for microsurgical skills training. The training model conformed to the 3 R's principle of experimental animals used (3 R's: reduce the number of animals used, replace as many as possible with model, and refine the experimental design). 3 The training strategy has been confirmed to be effective through practice. The main aim of the article is to offer a beneficial inspiration: how to convert some waste experimental animal carcasses into teaching and learning resources. It must be emphasized here that large animals used specially for microsurgical skills training are not advocated absolutely.First, we researched the intercostal anatomy of common adult dogs and found that the anatomical features of intercostal spaces are very similar to those of intercostal spaces in a human body. There is a neurovascular bundle in each intercostal space, which has a strict order: vein-artery-nerve from superior to inferior. The internal intercostal muscles in dogs are smaller than those in human bodies. The parietal pleura cover the inside. The neurovascular bundles can be revealed after the parietal pleura have been incised on the inferior border of the rib and after some connective tissues have been dissected. The diameter of the intercostal arteries, veins, and nerves is approximately 0.4 to 0.6 mm, 0.5 to 0.7 mm, and 0.9 to 2 mm, respectively, which is suitable for training microsurgical skills. The rib, including the neurovascular bundles and the part of the intercostal muscles, was cut into segments of about 5 to 7 cm, wrapped by cling film, and preserved under the condition of -20°C for training microsurgical skills. Of course, the fresh intercostal neurovascular bundles, providing better structure texture of the anatomy, were optimal materials...