Step By Step: Microsurgical training method combining two nonliving animal models

Summary

Here we describe how to set up a small microsurgical practice station and a simple and inexpensive method for the training of microsurgery with non-living animal models.

Abstract

The learning of microsurgical techniques and the maintenance of microsurgical skills have been traditionally based on the use of living animals, mainly laboratory rats. This method although extremely valuable can be economically demanding both for the surgeon and the sponsoring institution; it also requires special training facilities that may not always be available or accessible. Furthermore ethical concerns can limit the use of living animals for training purposes. Alternative training methods, such as inert tubes and gloves have not gained popularity among surgeons since they do not offer an experience similar to that of a clinical situation. Non-living animal models include the use of chicken thighs and wings; they offer a practice experience that resembles a clinical situation to a considerable extent. This type of training is relatively cheap and easily available. The microscope and instruments required can be acquired over the internet, and the chicken pieces can be bought at the local supermarket.

This approach allows a motivated trainee to rehearse different types of surgical techniques several times at a reasonable expense, helping to develop or maintain his surgical expertise if more complex facilities are not available. On the current manuscript we describe how to setup a small practice station, how to dissect the specimens, and how to practice both with the chicken thighs and with the chicken wings in a progressive fashion. This approach takes advantage on the versatility of the chicken thigh model and the small size of the chicken wing Brachial artery.

Introduction

An ample array of training models have been described for the learning and maintenance of both basic and advanced microsurgical skills. These include living animals^1,2, human cadaveric specimens³, inert models^4,5 and non-living animal models^6-9.The Living animal models, specifically those using rats have been extensively used in the teaching of microsurgery ^1,2; and they are considered the current gold standard of training. In spite of their remarkable instructive value, when an intensive or prolonged training is required; economical and ethical concerns can hinder their practical usage.

Protocol

1. Preparation:

1. Obtain a tabletop stereo microscope, with a variable 3,5 x to 45x zoom, 200 mm working distance, 55 to 75 mm variable inter-pupillary distance and an accessory led ring light. Any similar microscope is adequate, it can be set up on a small table and is not extremely expensive.
2. Gather and prepare a set of microsurgical instruments with two microsurgical pickups, one dissecting scissor, and one needle-driver; this is the minimum required, it must be taken into account that these are practice instruments, and high end quality instruments are not needed.
3. Use 9/0 monofilament micro-suture for all the practices. Buy commercial....

Results

The authors have chronometered their times with the present training method and have seen it to significantly reduce the anastomosis times for a femoral artery at the end of the third week. The trainee can control the improvements on his technique by checking his times, his patency percentages and the alignment of his stitches. The system described in this manuscript is depicted in Figure 1 it includes a tabletop microscope and a set of microsurgical instruments. The macroscopic dissections are shown in Figures 2 and 3. .......

Discussion

The clinical practice of microsurgery requires a continuous practice and a high level of expertise; it’s applications include free flaps, replantation and revascularization procedures, intracranial – extracranial anastomoses for neurosurgical procedures, peripheral nerve surgery and others. In spite of the wide variety of procedures that require microsurgical techniques, some of them are seldom performed in many centers. The surgeons therefore need sometimes to maintain their skill level rehearsing the surge.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Stereomicroscope	Amscope	SM-1BX	Microscope
Led light	Amscope	LED-80S-YA	illumination system
Microsurgical instruments set	Chen hen microsurgical instruments	HC- X803-1	Microsurgical instruments
Microsurgical sutures	S/T microsurgical	9/0 Suture	Sutures