Microsurgical skills training: A new concept for simulation of vessel-wall suturing

Abstract

Initiation of training in basic microsurgical suturing technique usually involves placing sutures on incisions made on latex sheets, and then progressing to a live anastomosis in a rat model. A straight incision resembles a skin incision and does not mechanically simulate vessel wall suturing, and various modifications and innovative prosthetic models continue to be developed to bring the simulation closer to a live anastomosis. We developed two models which closely simulate vessel wall suturing and require the application of similar skills by the trainee. In the first model (the "I" model), the straight 1-cm incision is converted to an I-shaped incision which increases the instability of the edge to be sutured, depending on the length of the horizontal incision, putting greater demand on dexterity in suture placement similar to a vessel. The length (1 cm) of the edge does not constrain the spacing of the sutures and can be used for the beginner. The second model (the "double triangle" model) creates a narrow and unstable edge for placing sutures, and puts greater demand on bimanual coordination and instrument control for training in accuracy of suture placement as well as spacing between sutures. Both these models are cost-effective and simple to construct.

Assessment of the microsurgical skills: 30 minutes versus 2 weeks patency

“…In a further step, in order to obtain better resemblance to vessel walls, we used the two models similar with those developed by Lahiri and Lim: the ''I-shaped'' model and the ''double triangle'' model. 11 After getting used to body and hands position, as well as to handling the microsurgical instruments properly when tying knots at a high magnification, we went on to perform anastomosis on pig coronary arteries. At this point, we were looking for accurate alignment of the intimae, symmetrical suture placement, and knots lying flat and not generating excessive tension in the anastomotic site.…”

Validation of microsurgical models in microsurgery training and competence: A review

“…Lahiri et al described a modification of the use of latex sheet/gloves to practice vessel-wall suturing using vinyl examination gloves and a straight-line vs. double triangle models for two level of training in placement and spacing of sutures. 23 These models have potentially construct validity, but lack face validity because of no resemblance of normal human tissue.…”

Entrenamiento microquirúrgico básico para realizar un modelo animal de alotrasplante compuesto vascularizado

“…En la literatura varios artículos describen los elementos necesarios para aprender microcirugía. Algunos de estos aspectos son la necesidad de tiempo, paciencia, motivación, tolerancia a la frustración y recursos entre otros 4,13,[27][28][29][30][31] . Si bien existen algunas publicaciones al respecto, aún no se ha desarrollado un currículo válido de entrenamiento para los especialistas que necesitan usar técnicas microquirúrgicas en su práctica diaria 29,[32][33][34][35][36] .…”