Pulsatile Perfused Porcine Coronary Arteries for Microvascular Training

Abstract

Microsurgery is today an established technique in specialties such as plastic surgery, neurosurgery, and trauma surgery. However, specialized training is a prerequisite for mastering anastomosis of small-diameter vessels or coaptation of nerves in the operating room. The training should be as realistic as possible and thus, laboratory animals such as the rat are preferably used as a substitute. In an attempt to minimize the use of living animals without jeopardizing a realistic training setting, we developed a pulsatile perfused porcine coronary artery model for microsurgical education. The training model consists of a membrane pump that generates a pulsatile flow within a coronary artery of a porcine heart. The pump is commercially available with a dimension of approximately 130 x 100 x 60 mm and a weight of 190 g. The pump is energized by 220 B and the motor is run on a transformed power of approximately 12 V (range, 1.5-12 V). Different fluids from simple saline solution to theoretically whole blood can be used for perfusion. The membrane pump proved to be very reliable during microvascular training because of its convenient size and wide range of feed rate providing a very realistic training setting. A maximum fluid output of 850 mL/min can be achieved. The pump has a high acceptance in microsurgical trainees evaluated by questionnaires during several microsurgical courses. The pulsatile perfused porcine coronary artery system for microsurgical training enables the trainee to work under the most realistic training settings. It proved to be a valuable tool during microsurgical education, reducing the costs and sparing living laboratory animals. Thus, we can recommend this system to anyone who is involved in training and teaching microsurgical skills.

Evaluation of the Efficacy of Microsurgical Practice Through Time Factor Added Protocol

“…19,20 However, nonbiologic materials are somewhat different from biologic vessels, which make these exercises less similar to the actual surgical experience and expensive. Various nonvital biologic materials, such as placenta, 21,22 chicken ring, 6Y8 pig leg, 16 and pig heart, 3 have been considered. These too, however, required extensive time for practicing.…”

“…Therefore, these techniques must be acquired during special courses or experimental projects in the laboratory. 3 In most cases, living animals are used, and of all the laboratory animals, anesthetized rats with their femoral vessels are considered to be the standard live model. 3 However, they are neither convenient nor practical for routine exercises or rehearsals.…”

“…3 In most cases, living animals are used, and of all the laboratory animals, anesthetized rats with their femoral vessels are considered to be the standard live model. 3 However, they are neither convenient nor practical for routine exercises or rehearsals. 6 In addition, for a very busy trainee, too much time and effort are needed for the trial and error phase with living animals.…”

Learning Surgical Anatomy in the Field of Microsurgical Reconstructive Surgery: A new Pedagogic Method on Human Fresh Cadavers

“…Animals models are very useful for basic microvascular anastomosis learning but, because the growing ethical awareness and stricter animal protection, other training models have been found. Some authors proposed to use animal cadaver vessels perfused in vitro for microvascular training as legs vessels of slaughtered pigs (Steffens et al, 1992), chicken wing vessels Krishnan et al, 2004), porcine coronary arteries (Schoffl et al, 2006). Other authors described synthetic models to simulate the live vessels (Korber & Kraemer, 1989;Weber et al, 1997;Meier et al, 2004;Matsamura et al, 2009;Spetzer et al, 2011) and to reduce the number of animals required for microsurgical training.…”

Training of microsurgical skills on nonliving models

“…Macroscopic dissection of the artery can be incorporated into the exercise, or the student can move directly to practicing the anastomotic steps on predissected arteries. Schoffl et al 14 significantly improved this nonvital model by using porcine hearts to create a pulsatile flow system. A membrane pump generates frequencies between 60 and 120 impulses/minute, through vessels whose diameters range between 0.5 and 4 mm.…”