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

Gallardo, Federico; Bustamante, Jorge Luis; Martin, Carol; Orellana, Cristian Marcelo; Caviglia, Mauricio Rojas; Oriola, Guillermo García; Diaz, Agustin Ignacio; Rubino, Pablo; Quilis-Quesada, Vicent

doi:10.1016/j.wneu.2020.07.116

Cited by 16 publications

(10 citation statements)

References 40 publications

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“…A further approach to presurgical clipping simulation taking aneurysm deformation into account is the use of 3D-printed aneurysm models prior to surgery [35][36][37][38][39][40][41][42][43][44]. These printed models represent an attempt to simulate aneurysm clipping with increasing complexity, adding blood flow simulation and aneurysm pulsation in some studies.…”

Section: Discussionmentioning

confidence: 99%

Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

et al. 2022

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Aneurysm occlusion rate after clipping is higher than after endovascular treatment. However, a certain percentage of incompletely clipped aneurysms remains. Presurgical selection of the proper aneurysm clips could potentially reduce the rate of incomplete clippings caused by inadequate clip geometry. The aim of the present study was to assess whether preoperative 3D image-based simulation allows for preoperative selection of a proper aneurysm clip for complete occlusion in individual cases. Patients harboring ruptured or unruptured cerebral aneurysms prior to surgical clipping were analyzed. CT angiography images were transferred to a 3D surgical-planning station (Dextroscope®) with imported models of 58 aneurysm clips. Intracranial vessels and aneurysms were segmented and the virtual aneurysm clips were placed at the aneurysm neck. Operating surgeons had information about the selected aneurysm clip, and patients underwent clipping. Intraoperative clip selection was documented and aneurysm occlusion rate was assessed by postoperative digital subtraction angiography. Nineteen patients were available for final analysis. In all patients, the most proximal clip at the aneurysm neck was the preselected clip. All aneurysms except one were fully occluded, as assessed by catheter angiography. One aneurysm had a small neck remnant that did not require secondary surgery and was occluded 15 months after surgery. 3D image-based preselection of a proper aneurysm clip can be translated to the operating room and avoids intraoperative clip selection. The associated occlusion rate of aneurysms is high.

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Section: Discussionmentioning

confidence: 99%

Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

et al. 2022

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“…During the practice it was found that the placenta can be use at 20-22 ° without refrigeration at least for 6-8 hours before the tissue turns friable and delicate. Regarding the preparation process, most of the previous studies describe the use of saline solution (8) and heparine ( 6) and then perfusing it with colored normal saline (with different types of dye solutions) (1,3,7). Other reports have used silicone plus catalyst for simulation of tumors (9).…”

Section: Dye Instillationmentioning

confidence: 99%

“…Ex vivo models include cadaveric human specimens, bovine or human placentas, chicken or turkey wings, and thighs. Rats are typically used for in vivo studies (1)(2)(3). One of its limitations is that the use of live animals in microsurgery laboratories is restricted by law, requires more infrastructure and qualified staff, raises expenses, and has serious ethical implications (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] One of its limitations is that the use of live animals in microsurgery laboratories is restricted by law, requires more infrastructure and qualified staff, raises expenses, and has serious ethical implications. [2][3][4] Currently, the use of the human placenta has been described as part of comprehensive microsurgical training programs that combine the use of multiple synthetic, ex vivo, and in vivo models in order to promote progressive learning and limit the use of live animals. 4 The present study describes a technique for preparing the human placenta with color perfusion for use as a simulation model in the basic microsurgery laboratory (►Fig.…”

Section: Introductionmentioning

confidence: 99%

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Dye-Perfused Human Placenta for Simulation in a Microsurgery Laboratory for Plastic Surgeons

et al. 2023

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Background: The placenta as a simulation model is used for training in microvascular repair techniques as an alternative to the use of live animals and has been validated mainly in microneurosurgery. This study performs a characterization of the placental vascular tree to determine its applicability for microsurgical training and reports the results of an assessment by residents and plastic surgeons. Methods: The placental vessels were measured, and the morphological characterization of 18 placentas was performed. A survey was administered to 9 plastic surgery residents, 2 microsurgeons, and 1 hand surgeon after the implementation of the model in a basic microsurgery training laboratory session. Results: Venous diameters were greater than arterial diameters in all divisions, obtaining minimum diameters of 0.8 mm and 0.6 mm, respectively. Most of the participants considered that they somewhat agreed or absolutely yes that the model faithfully reproduces a real microsurgical scenario and that the consistency of the vessels and their dissection is similar in in-vivo tissue. Furthermore, all the participants considered that this model could improve their surgical technique, reduce errors, and would propose it as a tool for microsurgical training. As some of the model's disadvantages, an abundant thick adventitia, a thin tunica media, and higher adherence to the underlying tissue were identified. Conclusions: The color-perfused placenta is an excellent tool for microsurgical training in plastic surgery. It can faithfully reproduce a microsurgical scenario, providing abundant vasculature with variable diameters comparable to tissue in vivo. This can improve technical skills and reduce patient error

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“…The porcine [46] and bovine [85] hearts and the microsurgical simulation model with pulsatile flow system [86] have been devised as alternative methods of education for the trainee microsurgeon. Another example is the home-based microsurgical training model; this modality was shown to be a realistic, cheap, and reproducible tool to help the trainee microsurgeon to maintain already obtained skills [87,88].…”

Section: Advantages Of Virtual Reality and Nonliving Training Modelsmentioning

confidence: 99%

Superiority of living animal models in microsurgical training: beyond technical expertise

et al. 2021

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

Cited by 16 publications

References 40 publications

Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

Dye-Perfused Human Placenta for Simulation in a Microsurgery Laboratory for Plastic Surgeons

Superiority of living animal models in microsurgical training: beyond technical expertise

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