Microsurgery training card: a practical, economic tool for basic techniques

Novel Simulation Model with Pulsatile Flow System for Microvascular Training, Research, and Improving Patient Surgical Outcomes

BACKGROUND

Simulation allows surgical trainees to acquire surgical skills in a safe environment. With the aim of reducing the use of animal experimentation, different alternative nonliving models have been pursued. However, one of the main disadvantages of these nonliving models has been the absence of arterial flow, pulsation, and the ability to integrate both during a procedure on a blood vessel. In the present report, we have introduced a microvascular surgery simulation training model that uses a fiscally responsible and replicable pulsatile flow system.

METHODS

We connected 30 human placentas to a pulsatile flow system and used them to simulate aneurysm clipping and vascular anastomosis.

RESULTS

The presence of the pulsatile flow system allowed for the simulation of a hydrodynamic mechanism similar to that found in real life. In the aneurysm simulation, the arterial flow could be evaluated before and after clipping the aneurysm using a Doppler ultrasound system. When practicing anastomosis, the use of the pulsatile flow system allowed us to assess the vascular flow through the anastomosis, with verification using the Doppler ultrasound system. Leaks were manifested as "blood" pulsatile ejections and were more frequent at the beginning of the surgical practice, showing a learning curve.

CONCLUSIONS

We have provided a step-by-step guide for the assembly of a replicable and inexpensive pulsatile flow system and its use in placentas for the simulation of, and training in, performing different types of anastomoses and intracranial aneurysms surgery.

Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review

BACKGROUND

Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken.

METHODS

A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria.

RESULTS

Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators.

CONCLUSIONS

A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.

The human umbilical cord: a model for microsurgical training

Microsurgery continues to be a fundamental technique in many surgical subspecialties. In the past, many models have been utilized for microsurgery training. We are proposing the human umbilical cord as a training model, which is cheap, available and practical. This model can be used both for junior trainees to achieve good microsurgical skills before operating on human being and it can also help surgeons to maintain their skills.