Is There Good Simulation Basic Training for End-To-Side Vascular Microanastomoses?

Abstract

Background Microvascular anastomosis is the cornerstone of free tissue transfers. Irrespective of the microsurgical technique that one seeks to integrate or improve, the time commitment in the laboratory is significant. After extensive previous training on several animal models, we sought to identify an animal model that circumvents the following issues: ethical rules, cost, time-consuming and expensive anesthesia, and surgical preparation of tissues required to access vessels before performing the microsurgical training, not to mention that laboratories are closed on weekends. Methods Between January 2012 and April 2012, a total of 91 earthworms were used for 150 microsurgical training exercises to simulate vascular end-to-side microanastomosis. The training sessions were divided into ten periods of 7 days. Each training session included 15 simulations of end-to-side vascular microanastomoses: larger than 1.5 mm (n = 5), between 1.0 and 1.5 mm (n = 5), and smaller than 1.0 mm (n = 5). A linear model with the main variables being the number of weeks (as a numerical covariate) and the size of the animal (as a factor) was used to determine the trend in time of anastomosis over subsequent weeks as well as the differences between the different size groups. Results The linear model shows a significant trend (p \ 0.001) in time of anastomosis in the course of the training, as well as significant differences (p \ 0.001) between the groups of animals of different sizes. For microanastomoses larger than 1.5 mm, the mean anastomosis time decreased from 19.3 ± 1.0 to 11.1 ± 0.4 min between the first and last week of training (decrease of 42.5 %). For training with smaller diameters, the results showed a decrease in execution time of 43.2 % (diameter between 1.0 and 1.5 mm) and 40.9 % (diameter \1.0 mm) between the first and last periods. The study demonstrates an improvement in the dexterity and speed of nodes execution. Conclusion The earthworm appears to be a reliable experimental model for microsurgical training of endto-side microanastomoses. Its numerous advantages are discussed here and we predict training on earthworms will significantly grow and develop in the near future.

Status of Microsurgical Simulation Training in Plastic Surgery

“…1 Various simulation assessment tools have been validated and deemed reliable in measuring residents' technical skills outside the operating room across multiple specialties, including microsurgery. 3,[5][6][7][8][9][10][11][12][13] In addition, various simulation training modules have been validated for improving performance in the operating room with training. [14][15][16][17][18][19][20] Despite these advances in microsurgical education, it is unknown how prevalent simulation is.…”

Longitudinal Microsurgery Laboratory Training during Hand Surgery Fellowship

“…23 A more practical option for institutions without access to an animal laboratory is one of the many other low-cost models that have been described including chicken thighs, earthworms, porcine spleens, turkey wings, human placentas, cryopreserved rat aortas, and synthetic arteries complete with fascia. 6,7,22,[24][25][26][27] In our opinion, these are less ideal than a live animal model, which we therefore feel is worth the additional expense.…”

Is There Bias against Simulation in Microsurgery Training?

“…What constitutes simulation is highly variable in the literature. There are a diverse array of "simulators" available, ranging from silicone tubes and the well-known rat hind limb and turkey wing models, to the earthworm model, 6 home-grown simulators, 7 and the Japanese noodle anastomosis. 8 Simulators are generally described as lowtech or high-tech.…”