Submerged vascular anastomosis. A technique for vascular suturing in experimental microsurgery

Abstract

Purpose: To evaluate the impact of submersion of the microsurgical anastomosis suture area using saline (0.9% NaCl) in an experimental laboratory during the training of medical students and resident physicians. Methods: Wistar rats (n = 10) were selected to have the two femoral arteries sectioned and anastomosed end-to-end under optical magnification. They were randomly divided, so that on one side suturing was performed under submersion with saline, and the contralateral side was kept dry during the procedure. The surgical times, as well as the patency within 30 min and 72 h of the procedure, were evaluated. Results: Six male Wistar rats survived the surgical anesthetic procedure, with the average initial weight of 243.3 g and the average artery diameter of 0.86 mm, with average time of 15.67 min for the submerged technique and 20.50 min for the dry technique (p = 0.03). The failure rates were 17 and 50% for the submerged group and the dry one, respectively (p = 0.62). Conclusion: Submerged microvascular suture does not compromise the patency of the vessel or increase the time of anastomosis. Therefore, it is a strategy that can be applied by the surgeon according to his/her technical preferences.

A microscope in your pocket: can smartphones be used to perform microsurgery?

“…Patency rates in experimental microsurgery vary greatly in the literature and depend on training time, experience, size of the vessels addressed and observation time of the animals to assess patency 7 . Therefore, the result of a high patency rate in the microscope group was expected, suggesting that the smartphone group should also achieve a success rate of at least 50%.…”

Towards a standardized initial training program in experimental microsurgery for pediatric surgeons

“…Because of their relative infrequency, surgeons in training have little or no opportunity to deal with them before becoming specialists, which results in a lack of confidence in conducting these procedures safely and autonomously. Experimental practice helps to create a sound and secure foundation by simulating the aforementioned infrequent scenarios as closely as possible (11) . With this goal in mind, we designed an experimental microsurgery program with small live animals for pediatric surgical residents.…”

“…With longer assessment periods in the practice time, the learning curve can probably be better delineated, and an optimal and complete program with different degrees of complexity can be developed. The establishment of surgical tactics and techniques that allow the procedure to be carried out with greater ease will increase motivation, stimulate continuity, and improve the surgeon's overall quality during training (11) .…”

Hacia un programa inicial de formación estandarizado en microcirugía experimental para cirujanos pediátricos

“…Por su relativa infrecuencia, los cirujanos en formación tienen pocas o ninguna oportunidad para enfrentarse a ellas antes de convertirse en especialistas, generando una falta de confianza a la hora de realizar estos procedimientos con seguridad y autonomía. La práctica experimental, contribuye a la creación de una base sólida y segura, al simular de la manera más fidedigna posible los escenarios infrecuentes antes mencionados (11) . Con este objetivo, diseñamos un programa de microcirugía experimental con animales vivos de pequeño tamaño para residentes de cirugía pediátrica.…”

“…Probablemente con periodos de evaluación más largos en el tiempo de práctica se pueda delinear mejor la curva de aprendizaje y obtener un programa óptimo y completo con diferentes grados de complejidad. El establecimiento de tácticas y técnicas quirúrgicas que permitan realizar el procedimiento con mayor facilidad aumentará la motivación, estimulará la continuidad y mejorará la calidad general del cirujano durante el entrenamiento (11) .…”