Microsurgical training course for clinicians and scientists at a German University hospital: A 10‐year experience

Klein, Ingo; Steger, Ulrich; Timmermann, W.; Thiede, A.; Gassel, H.‐J.

doi:10.1002/micr.10180

Cited by 49 publications

(47 citation statements)

References 16 publications

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“…1,9 Yaşargil noted that, as a young surgeon, he had a mental barrier to skull base surgery because he felt uncomfortable and inexperienced with skull base anatomy and high-speed drill technology, which he ameliorated through his experience in the dissection laboratory. 16 It is only logical that this component of training should become a component of the surgical educational experience.…”

Section: Discussionmentioning

confidence: 99%

Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training

Liu¹,

Kshettry²,

Recinos³

et al. 2015

JNS

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T he establishment of formal surgical training in the US originated with William Stewart Halsted when he established the training program at The Johns Hopkins Hospital in 1889. According to Halsted's philosophy, surgical training was predicated on an apprenticeship model based on several principles, among which included a close association between the resident and the professor, as well as an "indefinite tenure" of training. Recently, greater scrutiny of residency education and patient safety has led to necessary modifications in how physicians are trained.5 Duty-hour limitations established by the Accreditation Council of Graduate Medical Education (ACGME) have caused all medical specialties to reevaluate their educational curriculum, but surgical specialties may have been the most affected. Duty-hour constraints have led many neurosurgical senior residents and program directors to acknowledge that these limitations have had an adverse effect on the surgical training experience. 4,8 Pressures to improve patient safety, outcomes, and hospital efficiency are also likely to exert an effect on residency education by limiting surgical autonomy.3 The combination of these external pressures has caused training programs to reevaluate their approach to surgical education to improve the efficiency of surgical training. One strategy is to employ more hands-on training by incorporating environments into residency training that simulate the operating room experience.To comply with the newly developed mandates on surgical education, neurosurgical training programs will likely need to develop strategies for systematically assessing a trainee's surgical competency prior to graduation. The best way to develop these skills and perform such an asabbreviatioNs ACGME = Accreditation Council of Graduate Medical Education; PGY = postgraduate year. Surgical education has been forced to evolve from the principles of its initial inception, in part due to external pressures brought about through changes in modern health care. Despite these pressures that can limit the surgical training experience, training programs are being held to higher standards of education to demonstrate and document trainee competency through core competencies and milestones. One of the methods used to augment the surgical training experience and to demonstrate trainee proficiency in technical skills is through a surgical skills laboratory. The authors have established a surgical skills laboratory by acquiring equipment and funding from nondepartmental resources, through institutional and private educational grants, along with product donations from industry. A separate educational curriculum for junior- and senior-level residents was devised and incorporated into the neurosurgical residency curriculum. The initial dissection curriculum focused on cranial approaches, with spine and peripheral nerve approaches added in subsequent years. The dissections were scheduled to maximize the use of cadaveric specimens, experimenting with techniques to best preserve the tiss...

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Section: Discussionmentioning

confidence: 99%

Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training

Liu¹,

Kshettry²,

Recinos³

et al. 2015

JNS

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“…Numerous free flaps have been described in the rat 10,16,18,[37][38][39] . The most commonly used for teaching and research purposes have been the transverse rectus abdominis myocutaneous flap, the latissimus dorsi and serratus anterior muscle flaps, the hind limb replantation model, and the epigastric (groin) flap 18,35 .…”

Section: Significance With Respect To Existing Methodsmentioning

confidence: 99%

“…However, even today surgical trainees are frequently daunted by the complexity of several steps involved in raising, transferring and insetting a free flap with the use of microsurgical techniques and instruments 8,9 . In addition, it is widely accepted that to become a proficient microsurgeon, extensive experimental practice in an animal model is mandatory 4,[8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

Casal

Pais

Iria

et al. 2017

JoVE

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Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat.This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue.Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training.

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“…14,15 However, the opportunity to learn and train in microsurgical techniques is usually restricted to clinical settings where patients undergo operations. 11,12 Teaching microsurgery, however, calls for preclinical training, and first steps cannot be performed on patients. 12 From the animal-ethics points of view, there should be no difference between experimental and companion cats.…”

Section: à13mentioning

confidence: 99%

Training protocol for feline renal transplantation, using rat vascular anastomosis

Iwai¹,

Endo²,

Kobayashi

2006

Microsurgery

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Renal transplantation (RTx) has been a potential treatment for renal failure in pet cats. We developed a training protocol for the microsurgical skills required for feline RTx using rat vessels, which are the same size as the feline renal artery and vein. Using interrupted sutures, the transected abdominal aorta was reestablished in an end-to-end fashion. Venous anastomosis was performed with a continuous running suture in an end-to-side fashion between the portal vein and inferior vena cava. In the arterial anastomotic model, technical errors were checked by postoperative hemorrhaging. Those failures in the venous anastomotic model, technical errors were confirmed by the rat's death. Histological examinations of the epithelialization at the anastomotic site were evaluated in both groups. After training, nine cases of feline RTx were performed safely, using an adequate microsurgical technique.

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Microsurgical training course for clinicians and scientists at a German University hospital: A 10‐year experience

Cited by 49 publications

References 16 publications

Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training

Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

Training protocol for feline renal transplantation, using rat vascular anastomosis

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