Reduction of the Number of Live Animals Used for Microsurgical Skill Acquisition: An Experimental Randomized Noninferiority Trial

Abstract

Background Live animals have been used for decades as one of the many training models for developing surgical skills. Microsurgery in particular relies on training for skill acquisition and maintenance, using live animal models, especially rats (murine models). Efforts are underway to reduce the number of rats sacrificed to achieve this objective. Methods A group of students with minimal microsurgical experience, after having gone through a basic microsurgical course, were randomly split into three equal groups, all three groups following a 24-week standard training program based on low- and medium-fidelity training models with standardized murine training days. In addition to the standard training regimen, each participant performed supplementary training on live rats every 4, 6, or 8 weeks. According to the training program, the procedures have been performed on chicken legs, flower petals, and rats, each procedure being blindly assessed and evaluated using validated models and scales. The primary evaluated outcome was the Stanford Microsurgery and Resident Training (SMaRT) scale result of the final rat anastomosis performed by each group, for which the tested hypothesis was one of noninferiority. The secondary outcomes were represented by the final rat anastomosis time, final chicken leg anastomosis result and time, and the final petal score. Results After the 24th week, no differences were observed between the three groups regarding their microsurgical skills, as measured by the aforementioned surgical outcomes. All participants improved significantly during the study (mean [standard deviation] 19 ± 4 points on the SMaRT scale), with no significant differences between the groups, p < 0.001 for noninferiority. Conclusion A training regimen based on low- and moderate-fidelity models, with the addition of training on a live rat every 8 weeks was noninferior to a training regimen that used a live rat every 6 weeks and also noninferior to a training regimen that used a live rat every 4 weeks.

Impact of High-Fidelity Microvascular Surgery Simulation on Resident Training

“…Simulation for microsurgical training has been shown to improve trainees' skill, comfort level, and overall knowledge in residents. 8,9 Balancing patient safety with resident education in reconstructive microsurgery can be difficult and as a result, direct participation in these challenging cases is often reserved for senior residents and fellows. Many training programs offer junior residents some form of simulated microsurgical training.…”

Fundamentals of Microsurgery: A Novel Simulation Curriculum Based on Validated Laparoscopic Education Approaches

“…20 Existing training curricula and programs rely on the use of live or cadaveric animals for evaluation of anastomosis. 12,14,15,22,[28][29][30]37,39,47 Reduction in use or even elimination of animals in microsurgical training does not have a negative impact on microsurgical skill acquisition and instead may improve proficiency. 14,15 In turn, we believe a nonbiologic model is ideal for teaching basic microsurgical skills since it allows skill acquisition in a competency-and proficiency-based manner.…”

“…12,14,15,22,[28][29][30]37,39,47 Reduction in use or even elimination of animals in microsurgical training does not have a negative impact on microsurgical skill acquisition and instead may improve proficiency. 14,15 In turn, we believe a nonbiologic model is ideal for teaching basic microsurgical skills since it allows skill acquisition in a competency-and proficiency-based manner. [9][10][11] Most plastic surgery residency programs desire a mandatory curriculum in microsurgery.…”

“…[9][10][11][12][13] Live animal laboratories provide a high-fidelity environment; however, they have several disadvantages including ethical concerns, cost, and time required to prepare and care for the animals. [3][4][5][9][10][11]14,15 Many microsurgical training courses offer nonbiologic models as useful alternatives to the live animal model. These models can be isolated tasks or incorporated into training curricula using cadaveric models for anastomosis practice.…”

O que os olhos não veem a microcirurgia ensina: modelo de treinamento oftalmológico com olho de boi

“…Desse modo, um modelo animal que respeite os 3Rs, evite o desperdício de tecido animal, possua um baixo custo e simule com maior similaridade as estruturas do globo ocular humano é de extrema relevância para o treinamento de habilidades microcirúrgicas do residente de oftalmologia. (13,14) A aplicação de um modelo ético para o treinamento de transplante e sutura de córnea é essencial, pois o residente de Oftalmologia só é introduzido à cirurgia de córnea após o terceiro ano de residência. O treinamento é eficaz para a melhoria da qualidade e destreza cirúrgicao que é benéfico para o paciente, que já essa não será, pois, mais a primeira tentativa cirúrgica do médico aprendiz, e, para este, que poderá oferecer procedimentos com mais segurança e qualidade.…”