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Gasteratos K, Paladino JR, Akelina Y, Mayer HF. Superiority of living animal models in microsurgical training: beyond technical expertise. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:167-176. [PMID: 33589852 PMCID: PMC7875764 DOI: 10.1007/s00238-021-01798-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
Background Many studies are investigating the role of living and nonliving models to train microsurgeons. There is controversy around which modalities account for the best microsurgical training. In this study, we aim to provide a systematic literature review of the practical modalities in microsurgery training and compare the living and nonliving models, emphasizing the superiority of the former. We introduce the concept of non-technical skill acquisition in microsurgical training with the use of living laboratory animals in the context of a novel proposed curriculum. Methods A literature search was conducted on PubMed/Medline and Scopus within the past 11 years based on a combination of the following keywords: “microsurgery,” “training,” “skills,” and “models.” The online screening process was performed by two independent reviewers with the Covidence tool. A total of 101 papers was identified as relevant to our study. The protocol was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Living models offer the chance to develop both technical and non-technical competencies (i.e., leadership, situation awareness, decision-making, communication, and teamwork). Prior experience with ex vivo tissues helps residents consolidate basic skills prior to performing more advanced techniques in the living tissues. Trainees reported a higher satisfaction rate with the living models. Conclusions The combination of living and nonliving training microsurgical models leads to superior results; however, the gold standard remains the living model. The validity of the hypothesis that living models enhance non-technical skills remains to be confirmed. Level of evidence: Not ratable.
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Affiliation(s)
- Konstantinos Gasteratos
- Department of Plastic and Reconstructive Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Yelena Akelina
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY USA
| | - Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
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Microsurgery training: A combined educational program. Injury 2020; 51 Suppl 4:S131-S134. [PMID: 32173081 DOI: 10.1016/j.injury.2020.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/19/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
A proposed microsurgical training program is presented that includes all the existing training methods, such as simulation in nonliving models, virtual reality simulation system and exercise in living models. Our experience in microsurgery training over the last decades indicates the need of evolution in training programs. This can be achieved with the introduction of new technologies into education and training. The first primary results of the described training program are promising, however this system needs to be assessed by training greater number of microsurgeons. Furthermore, more complex scenarios (such as whole operations) should be inserted into the virtual reality simulation system to create a more interactive experience.
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Bigorre N, Saint-Cast Y, Cambon-Binder A, Gomez M, Petit A, Jeudy J, Fournier HD. Fast-track teaching in microsurgery. Orthop Traumatol Surg Res 2020; 106:725-729. [PMID: 32359954 DOI: 10.1016/j.otsr.2020.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In France, microsurgery is taught in University diploma courses, for a mean 100hours (range, 45-120hours) extending over several months. This training, spread over the year, encounters problems of maintaining high-quality supervision and enduring acquisition of skills. These difficulties risk leading to withdrawal of certain courses, already suffering from funding issues and administrative requirements for animal welfare. MATERIAL AND METHOD We report our experience with a 2-week module comprising nine 4-hour sessions (total, 36hours), with continuous supervision of 5 students in each of 2 groups (10 students), enabling personalized learning. At the end of each session, an assessment questionnaire was filled out by teachers and students. RESULTS Students' scores increased from a mean 23.9/30 points (range, 20 - 30) at session 3 to 26.9 points (range, 23 - 30) at session 9 (p=0.012). At the end of session 3, students were grouped as good, average or beginners, based on the first assessments: i.e., with differences in level between groups at session 3. At the end of session 9, all 3 groups showed statistically comparable levels. Comparison between student and teacher questionnaire responses showed a significant discrepancy in 7 of the 10 cases in week 1, and no significant discrepancy in 7 of the 10 cases by the end of week 2. DISCUSSION The efficacy of condensed learning is based on immediate repetition of exercises, following Ebbinghaus: without repetition, memory decays exponentially, whereas if the information is rapidly repeated, the curve flattens and memory is consolidated. The present rapid improvement in the acquisition of the principles of microsurgery stimulated the enthusiasm of both students and teachers for what is reputed to be a demanding type of training. The study showed that acquisition, assessed in terms of vascular suture reliability, was achieved by the end of a 36-hour module, regardless of the student's baseline level.
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Affiliation(s)
- Nicolas Bigorre
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France.
| | - Yann Saint-Cast
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
| | - Adeline Cambon-Binder
- Service de Chirurgie Orthopédique et Traumatologique, SOS Mains, Hôpital Saint-Antoine, Paris, France
| | - Mathurin Gomez
- Département de Chirurgie Osseuse, CHU Angers, 4, rue Larrey, 49033 Angers cedex 3, France
| | - Alexandre Petit
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
| | - Jérôme Jeudy
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
| | - Henri Dominique Fournier
- CHU Angers-Neurochirurgie, 4, rue Larrey, 49033 Angers cedex 3; Faculté de Médecine, Laboratoire d'Anatomie, Université Angers, rue Haute de Reculée, 49045 Angers, France
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Schöffl H, Froschauer SM, Dunst KM, Hager D, Kwasny O, Huemer GM. Strategies for the Reduction of Live Animal Use in Microsurgical Training and Education. Altern Lab Anim 2019; 36:153-60. [PMID: 18522483 DOI: 10.1177/026119290803600206] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Harald Schöffl
- Department of Trauma Surgery, Allgemeines Krankenhaus Linz, Linz, Austria
- Mikrochirurgisches Ausbildungs- & Forschungszentrum (maz), Linz, Austria
- Centre for Alternatives and Complementary Methods to Animal Testing (zet), Linz, Austria
| | - Stefan M. Froschauer
- Department of Trauma Surgery, Allgemeines Krankenhaus Linz, Linz, Austria
- Mikrochirurgisches Ausbildungs- & Forschungszentrum (maz), Linz, Austria
| | - Karin M. Dunst
- Mikrochirurgisches Ausbildungs- & Forschungszentrum (maz), Linz, Austria
| | - Dietmar Hager
- Department of Trauma Surgery, Allgemeines Krankenhaus Linz, Linz, Austria
- Mikrochirurgisches Ausbildungs- & Forschungszentrum (maz), Linz, Austria
| | - Oskar Kwasny
- Department of Trauma Surgery, Allgemeines Krankenhaus Linz, Linz, Austria
- Mikrochirurgisches Ausbildungs- & Forschungszentrum (maz), Linz, Austria
| | - Georg M. Huemer
- Mikrochirurgisches Ausbildungs- & Forschungszentrum (maz), Linz, Austria
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Kobayashi E, Haga J. Translational microsurgery. A new platform for transplantation research. Acta Cir Bras 2016; 31:212-7. [PMID: 27050793 DOI: 10.1590/s0102-865020160030000010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/19/2016] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Clinical microsurgery has been introduced in many fields, while experimental microsurgery has the cross-disciplinary features of the sciences and techniques for growth of medicine, pharmacology, veterinary, engineering etc. Training protocol, proposing a new name as Translational Microsurgery, was introduced. METHODS Reconstructive skills of hepatic artery in pediatric living donor liver transplantation were summarized. Ex vivo training protocol using artificial blood vessel for surgeons was proposed. RESULTS Clinical microsurgery requires anastomosis with delicate arteries and limited field of view. Our training protocol revealed that the relation between the score and speed was seen, while not all the surgeons with enough experience got high score. This training led to muster clinical skills and to apply excellent experimental works. CONCLUSIONS Our microsurgical training protocol has been planned from the points of clinical setting. Training for vascular anastomosis led to rodent transplantation models. These models were used for immunology and immunosuppressant research. Microsurgical techniques led to master catheter technique and to inject various drugs or gene vectors.
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Affiliation(s)
- Eiji Kobayashi
- Department of Organ Fabrication, School of Medicine, Keio University, Tokyo, Japan
| | - Junko Haga
- Department of Organ Fabrication, School of Medicine, Keio University, Tokyo, Japan
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Liu EY, Li B, Hutnik CML. Canadian ophthalmic microsurgery course: an innovative spin on wet lab-based surgical education. Can J Ophthalmol 2016; 51:315-320. [PMID: 27769319 DOI: 10.1016/j.jcjo.2016.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/18/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
Wet lab and surgical simulation can reduce the learning curve of difficult surgical techniques, accelerate the rate for trainees to achieve surgical competency, and improve patient safety. To provide the most up-to-date information and hands-on experiences with novel ophthalmic surgical techniques and instruments, the Department of Ophthalmology at Western University has created a wet lab-based, multilevel microsurgery skills transfer course through collaboration with various industry partners. Several elements in the course goal and design differentiate this type of surgical course from typical wet labs: the format is multileveled surgical training, with a beginner level targeting undergraduate medical students, an intermediate level for ophthalmology residents, and an advanced level for trained ophthalmologist. In addition, the level of industry participation allows the development of true partnership and offers a method to introduce awareness and innovation in a cost-effective manner. This article presents the organization, course setup, and feedback from the pilot course.
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Affiliation(s)
- Eddie Y Liu
- Ivey Eye Institute, St Joseph's Health Care, Department of Ophthalmology, Western University, London, ON, Canada.
| | - Bo Li
- Ivey Eye Institute, St Joseph's Health Care, Department of Ophthalmology, Western University, London, ON, Canada
| | - Cindy M L Hutnik
- Ivey Eye Institute, St Joseph's Health Care, Department of Ophthalmology, Western University, London, ON, Canada
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Alzakri A, Al-Rajeh M, Liverneaux P, Facca S. État des lieux de l’enseignement des techniques microchirurgicales en France et à l’étranger. ACTA ACUST UNITED AC 2014; 33:219-23. [DOI: 10.1016/j.main.2014.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 03/25/2014] [Accepted: 03/31/2014] [Indexed: 11/28/2022]
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Dumestre D, Yeung JK, Temple-Oberle C. Evidence-based microsurgical skill-acquisition series part 1: validated microsurgical models--a systematic review. JOURNAL OF SURGICAL EDUCATION 2014; 71:329-38. [PMID: 24797848 DOI: 10.1016/j.jsurg.2013.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/08/2013] [Accepted: 09/05/2013] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The purpose of this study is to (1) systematically review all the literature pertaining to microsurgical training models and to (2) determine which of these are specific to and validated for microsurgery training. DESIGN PubMed, MEDLINE (OVID/EBSCO), Google Scholar, and Cochrane Central Register of Controlled Trials were searched using preset terms. The last search date was in July 2012. Articles of all languages, years of publication, sample sizes, and model types pertaining to microsurgery were included. The eligibility criteria included the use of a microsurgical training model on a subject group with statistical analysis and measures of validation. Two assessors independently reviewed the articles and their references. RESULTS Of the 238 articles reviewed, 9 articles met the criteria. Those excluded were predominantly model descriptions that had not been validated in a set of learners. The 9 models whose performances were assessed in a group of learners included an online curriculum, nonliving prosthetics and biologics, and the live rat femoral artery model. Each model was evaluated for content, construct, face, and criterion (concurrent and predictive) validity, as well as selection and observation/expectant bias. Content, construct, concurrent, and face validities were consistently demonstrated for all 9 models. Selection bias was also reliably well controlled with random allocation of participants to each study group. Observation/expectant bias was controlled in 6 of the 8 papers. Predictive validity, an arguably more difficult factor to measure, was only present in 1 article. CONCLUSIONS Despite a plethora of papers describing microsurgical learning tools, only 9 were discovered that provided validation of the proposed method of microsurgical skills acquisition. This review depicts the need for basic, yet well-designed studies that substantiate the effectiveness of microsurgical training models by using a subject group and demonstrating a statistical improvement with employment of the model. Ease of access, cost, and assessment tools used also require attention.
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Affiliation(s)
| | - Justin K Yeung
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Calgary, Alberta, Canada
| | - Claire Temple-Oberle
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Calgary, Alberta, Canada.
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Tellioglu AT, Eker E, Cimen K, Comert A, Karaeminogullari G, Tekdemir I. Training Model for Microvascular Anastomosis. J Craniofac Surg 2009; 20:238-9. [DOI: 10.1097/scs.0b013e3181843ade] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lausada NR, Escudero E, Lamonega R, Dreizzen E, Raimondi JC. Use of cryopreserved rat arteries for microsurgical training. Microsurgery 2005; 25:500-1. [PMID: 16134096 DOI: 10.1002/micr.20153] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Silastic tubes are used as training material for performing microvascular anastomoses. However, silastic texture differs from that of actual blood vessels. In the present work, we evaluate the use of preserved rat arterial segments for training in microvascular anastomoses. One-centimeter-long rat arterial segments were obtained from femoral, carotid, and abdominal arteries, preserved in cold saline solution, and frozen. Trainees performed microvascular anastomoses using the aforementioned material and answered questions about texture, consistency, and wall resistance to the needle, comparing preserved arterial wall and silastic tubes. They were also asked whether the arterial pedicles had a consistency and texture similar to normal vessels, and if they were a more reliable method for practicing microsurgery techniques than synthetic materials. They preferred frozen arterial pedicles over silastic tubes. We conclude that arterial cadaveric segments are a suitable biologic material for microsurgical training. Since they can be obtained from other experiments, this is an effective way to reduce the number of animals bred and sacrificed for teaching purposes.
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Affiliation(s)
- Natalia R Lausada
- Laboratorio de Transplante de Organos, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina.
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Krishnan KG, Dramm P, Schackert G. Simple and viable in vitro perfusion model for training microvascular anastomoses. Microsurgery 2004; 24:335-8. [PMID: 15274194 DOI: 10.1002/micr.20031] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this report, we describe a novel in vitro perfused microvessel model for training microvascular anastomotic exercises. Arteries and veins with a diameter of ca. 1 mm were explanted from chicken wings. These vessels were cannulated at both ends and mounted on a platform. Preserved, expired whole blood obtained from the blood bank was continuously injected through the proximal catheter, using an automatic perfusor. This in vitro perfused microvessel model exactly simulated the viable small-animal vessels. The setting is very simply and reliably repeated; the materials used are very cheap and universally available. There are no ethical questions involved. Vessels explanted from the human placenta or omentum may be used in a similar manner to gain the "feel" of functioning human microvascular tissue. But such materials are rarer and require the approval of ethical committees.
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Affiliation(s)
- Kartik G Krishnan
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Technical University of Dresden, Dresden, Germany.
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