Intraluminal endoscopic evaluation of microvascular anastomosis

Schöffl, Harald; Froschauer, Stefan M.; Hainisch, Reinhard; Hager, Dietmar; Schnelzer, Richard; Kwasny, O.; Huemer, Georg M.

doi:10.1016/j.bjps.2007.09.034

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…A recent study incorporating direct endoluminal evaluation has been used in experimental setting as a potential method for flap monitoring but has yet to be applied in the educational or clinical setting. 16 It is not clear which of these errors creates the greatest risk for anastomosis failure, which is an area for future study. Subendothelial vessel surfaces and adventitial collagen display thrombotic potential at the site of vessel anastomoses.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Type of Errors in Microsurgical Technique in Surgical Trainees

Stone

Doherty

Schrag

2016

J reconstr Microsurg

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Background The purpose of our study was first to identify microsurgical errors and their incidence. Identifying these common errors and the theoretical approach to prevent or repair them may provide benefit to trainees in the laboratory setting and, ultimately, in the clinical setting. Methods Using a rat femoral artery anastomoses model for resident microsurgical training, direct staff observation with real-time feedback and error identification was employed. Types of microsurgical errors were recorded and instructor feedback relayed to five resident participants. Results Errors were cataloged into five main categories: insufficient approximation (26.1%), vessel backwall (21.7%), incomplete bites (19.6%), tissue tear (19.6%), and irregular widths (13.0%). Further subdivision of the incomplete bite error based on vessel layer violated was performed. Representative figures were created outlining these errors. Conclusions We present common microsurgical errors in trainees and a training model with synchronous feedback. Visual images were designed outlining these errors as an adjunct for teaching.

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Section: Discussionmentioning

confidence: 99%

Incidence and Type of Errors in Microsurgical Technique in Surgical Trainees

Stone

Doherty

Schrag

2016

J reconstr Microsurg

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“…With flexible endoscopy, it is potentially possible to directly visualise the anastomosis after the initial suturing. We have developed a system involving the use of flexible miniature endoscopes, with diameters of 1mm and 2mm, that are introduced endoluminally into the anastomosed vessel (24). Specialised digital software is necessary for process-ing the displayed image, in which a single image is generated out of the video stream, showing a 2dimensional map of the inner surface.…”

Section: Microvascular Intraluminal Endoscopymentioning

confidence: 99%

Strategies for the Reduction of Live Animal Use in Microsurgical Training and Education

Schöffl

Froschauer

Dunst³

et al. 2008

Altern Lab Anim

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Education and training in microsurgical techniques have historically relied on the use of live animal models. Due to an increase in the numbers of microsurgical operations in recent times, the number of trainees in this highly-specialised surgical field has continued to grow. However, strict legislation, greater public awareness, and an increasing sensitivity toward the ethical aspects of scientific research and medical education, emphatically demand a significant reduction in the numbers of animals used in surgical and academic education. Hence, a growing number of articles are reporting on the use of alternatives to live animals in microsurgical education and training. In this review, we report on the current trends in the development and use of microsurgical training models, and on their potential to reduce the number of live animals used for this purpose. We also share our experiences in this field, resulting from our performance of numerous microsurgical courses each year, over more than ten years. The porcine heart, in microvascular surgery training, and the fresh chicken leg, in microneurosurgical and microvascular surgery training, are excellent models for the teaching of basic techniques to the microsurgical novice. Depending on the selected level of expertise of the trainee, these alternative models are capable of reducing the numbers of live animals used by 80–100%. For an even more enhanced, “closer-to-real-life” scenario, these non-animated vessels can be perfused by a pulsatile pump. Thus, it is currently possible to provide excellent and in-depth training in microsurgical techniques, even when the number of live animals used is reduced to a minimum. With these new and innovative techniques, trainees are able to learn and prepare themselves for the clinical situation, with the sacrifice of considerably fewer laboratory animals than would have occurred previously.

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“…Reproductions of clinical scenarios have included artificial skull and brain combinations for deep anastomosis as well as cadaver models (3,10). Results assessment of these models has included open and endoscopic intraluminal inspection (8).…”

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confidence: 99%