Lymphatic‐venous anastomosis in a rat model: A novel exercise for microsurgical training

Leuzzi, Sara; Maruccia, Michele; Annoscia, Paolo; Vestita, Michelangelo; Nacchiero, Eleonora; Giudice, Giuseppe

doi:10.1002/jso.25234

Cited by 13 publications

(10 citation statements)

References 21 publications

(30 reference statements)

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“…Lymph node flap transfer has gradually gained popularity for the treatment of both upper and lower limb lymphedema (Althubaiti, Crosby, & Chang, 2013;Azuma, Yamamoto, & Koshima, 2013;Becker, 2016;Chang, Masià, & Smith, 2018;Cheng, Koshima, Chang, & Masia, 2017;Giudice et al, 2017;Gould, Mehrara, Neligan, Cheng, & Patel, 2018;Kung et al, 2017;Lin et al, 2009;Masià, Pons, & Rodríguez-Bauzà, 2016;Patel, Lin, & Cheng, 2015;Schaverien, Badash, Patel, Selber, & Cheng, 2018;Silva & Chang, 2016). Several donor sites for lymph node flaps have been described, including the abdominal area Ciudad, Kiranantawat, Sapountzis, et al, 2015;Ciudad, Manrique, Date, Agko, et al, 2017;Ciudad, Manrique, Date, Sacak, et al, 2017;Di Taranto, Chen, Elia, et al, 2019;Di Taranto, Elia, Amorosi, et al, 2018;Leuzzi et al, 2018;Maruccia et al, 2019).…”

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confidence: 99%

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

et al. 2019

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Background Lymph node flap transfer has gradually gained popularity for the treatment of upper and lower limb lymphedema. The aim of this study is to present the outcomes of an integrated treatment protocol based on double gastroepiploic lymph node flap (DG‐VLN) and active physiotherapy in patients affected by Stage II and III lower extremity lymphedema. Methods All Stage II and III lower limb lymphedema patients operated between September 2015 and December 2017 were retrospectively identified and only those treated with an integrated approach of DG‐VLN flap and active physiotherapy were included. Outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy. Flap viability was evaluated through indocyanine green lymphography. Lymphedema related quality of life was evaluated preop and at 1 year follow up through LYMQOL questionnaire. Results Sixteen patients met inclusion criteria. Mean follow up was 26.2 months. Significant reduction in lower limb volume was observed for all patients from pre to post intervention. At 3 months of follow up, the mean CRR was 42.4% at below knee (BK) level and 25.4% at above knee (AK) level. At 12 months of follow up, the mean CRR was 58.3% at BK level (p = .001*) and 43.4% at AK level (p < .04*). LYMQOL metrics showed significantly better scores in all domains. Conclusions Patients with lower limb lymphedema can benefit from combined DG‐VLN flap and active physiotherapy, as this approach seem to fasten the onset of improvement and to have a positive impact on patients' quality of life.

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Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

et al. 2019

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“…10 Living rodent models are good for anastomosis training when using the thigh or intra-abdomen; however, vessel sizes are far smaller in the thigh, and there is a lack of subcutaneous dissection procedures in intra-abdominal models. 11,12 Several models using pig parts have been reported as good models of LVA due to their strong similarities with human structures. 3,13 They are also beneficial for performing ICG lymphography prior to anastomosis training, which is useful because accurate mapping of vessels preoperatively is important in clinical practice.…”

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Establishing a Lymphatic Venous Anastomotic Training Model in Pig Trotters

Kato

Kurita

Mito

et al. 2021

J Reconstr Microsurg

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Background Lymphatic venous anastomosis (LVA) is a widely accepted surgical procedure for lymphedema. To obtain the best outcomes, surgeons should be well trained. A recent study introduced an LVA training model using pig trotters for their utility and structural similarity to human tissues. However, details regarding the utilization of anastomosis models, such as feasible points for training based on vessel anatomy, have not been clarified. Therefore, we assessed the anatomical details of lymphatic vessels and veins of trotters to establish a practical training model of LVA. Methods Ten frozen trotters were used. After thawing at room temperature, indocyanine green fluorescent lymphography was used to visualize the lymphatic course. To dissect the lymphatic vessels and veins from the distal to the proximal end, whole skins were detached thoroughly from the plantar side. Data from the lymphatic vessels and veins were collected based on their courses, diameters, and layouts to clarify adjacent points feasible for LVA training. Results Both lymphatic vessels and veins were classified into four major courses: dorsal, medial, lateral, and plantar. The majority were dorsal vessels, both lymphatic vessels and veins. The adjacent points were always found in the distal dorsum center and were especially concentrated between the metacarpophalangeal (MP) joint and central interphalangeal crease, followed by the medial and lateral sides. Conclusion The most relevant point for LVA surgical training in the trotter was the dorsal center distal to the MP joint, where parallel vessels of similar sizes were found in all cases. This practical LVA surgical model would improve surgeon skills in not only anastomosis but also preoperative fluorescent lymphography.

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“…Joseph N Carey et al [11] There was a study from Leuzzi S et al [14] on lymphatic microsurgery course using a live rat model.…”

Section: Discussionmentioning

confidence: 99%

Microsurgery Training: Are the Live Models Era Coming in to the Tail? – A Literature Review

Hosain

2021

JAMMR

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Introduction: Microsurgery is a relatively new speciality with steep learning patterns. Before practice in real fields surgeons need adequate training to gain the expertise. Different types of living and non-living simulators are used to gain the efficiency. As the living simulator has issues with complexity, availability, cost, ethical approval and special setting and available resources an alternative less complex, inexpensive, no ethical issues, easily available, effective non-living models are demanded by the trainers. Objective: Review the relevant articles to see the justification of use of live models for microsurgery training and to see is there any alternative non-living model to replace living model. Materials and Methods: A PubMed and Google Scholar search for key words ‘(microsurgery) AND (training)) AND (live models)) AND (non-living models)) AND (education)’ were performed in February 2021. Total 422 literatures were found from January 1990 to February 2021. Among them 29 were found relevant with topics. Among them 17 were finally selected for discussion. Conclusion: Evidences showed non-living low fidelity models are as effective as high fidelity living model in microsurgery training. Many of the studies with ex vivo models have showed promising results which support replacement of live models in basic and intermediate courses. However, those are not sufficient to support for total ban of live models specially in advance microsurgery courses. We are hoping, in near future some blended non-living models may come up using digital or virtual reality technology which can replace the live model era. Further research with highest level of evidences are required.

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Lymphatic‐venous anastomosis in a rat model: A novel exercise for microsurgical training

Cited by 13 publications

References 21 publications

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

Establishing a Lymphatic Venous Anastomotic Training Model in Pig Trotters

Microsurgery Training: Are the Live Models Era Coming in to the Tail? – A Literature Review

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