New, Innovative, Three-Dimensional In Vivo Model for High-Level Microsurgical and Supermicrosurgical Training: A Replacement for Animal Models

Abstract

he wide field of microsurgery comprises surgical techniques that are characterized by the necessity of high-resolution surgical microscopes, magnifying glasses, and filigree surgical instruments to ensure precise handling of delicate tissue structures. Microsurgical methods are used in various disciplines, including plastic reconstructive surgery, 1 hand surgery, 2 maxillofacial surgery, 3 orthopedic surgery, 4 vascular surgery, 5 ophthalmology, 6 otorhinolaryngology, 7 urology, 8 and neurosurgery. 9 It is important to note that the performance of microvascular anastomoses strongly differs from conventional suturing practices; skills can hardly be obtained without specific training. 10 Basic microsurgical techniques, such as the implementation of vascular anastomoses and nerve coaptations, are performed in training courses in a variety of models. [11][12][13][14][15][16]

“Super-Microsurgical Anastomosis training using the chick embryos within the “Egg-in-Cube” system.”

“…[9][10][11][12][13][14][15] Although living animal models, such as rodents, are considered to be ideal microsurgical training models, [16][17][18][19] the use of living animal models is costly because of the special facilities and equipment required for breeding and anesthesia, as well as bioethical considerations. 20 In 2010, Yalcin et al 3 developed the ex ovo chicken embryo culture system and presented the microanatomy and potential application to the microsurgery of chicken embryos. A previous report introduced microsurgery training using the chick chorioallantoic membrane model to overcome the limitations of living animal models.…”

“…1 Third, it is technically difficult to place and prepare blood vessels and perform the microsurgical anastomosis through the small window made on the eggshell; this heavily limits the observation and accessibility of the tissue and vascular networks. 20,[24][25][26] Our supermicrosurgical anastomosis training system using the chicken embryo within the egg-in-cube has several advantages. First, this system is ethically acceptable, because the chick embryo is an experimental model containing no functional nerves before embryonic day 11.…”

“…9–15 Although living animal models, such as rodents, are considered to be ideal microsurgical training models, 16–19 the use of living animal models is costly because of the special facilities and equipment required for breeding and anesthesia, as well as bioethical considerations. 20…”

“…A previous report introduced microsurgery training using the chick chorioallantoic membrane model to overcome the limitations of living animal models. 20 However, this microsurgery training model has several drawbacks. First, embryo survival rate is low by the time the blood vessels grow to a usable size because of damage induced by cracking of the eggshell.…”

“…1 Third, it is technically difficult to place and prepare blood vessels and perform the microsurgical anastomosis through the small window made on the eggshell; this heavily limits the observation and accessibility of the tissue and vascular networks. 20,24–26…”