Strategies for the Reduction of Live Animal Use in Microsurgical Training and Education

Abstract

Education and training in microsurgical techniques have historically relied on the use of live animal models. Due to an increase in the numbers of microsurgical operations in recent times, the number of trainees in this highly-specialised surgical field has continued to grow. However, strict legislation, greater public awareness, and an increasing sensitivity toward the ethical aspects of scientific research and medical education, emphatically demand a significant reduction in the numbers of animals used in surgical and academic education. Hence, a growing number of articles are reporting on the use of alternatives to live animals in microsurgical education and training. In this review, we report on the current trends in the development and use of microsurgical training models, and on their potential to reduce the number of live animals used for this purpose. We also share our experiences in this field, resulting from our performance of numerous microsurgical courses each year, over more than ten years. The porcine heart, in microvascular surgery training, and the fresh chicken leg, in microneurosurgical and microvascular surgery training, are excellent models for the teaching of basic techniques to the microsurgical novice. Depending on the selected level of expertise of the trainee, these alternative models are capable of reducing the numbers of live animals used by 80–100%. For an even more enhanced, “closer-to-real-life” scenario, these non-animated vessels can be perfused by a pulsatile pump. Thus, it is currently possible to provide excellent and in-depth training in microsurgical techniques, even when the number of live animals used is reduced to a minimum. With these new and innovative techniques, trainees are able to learn and prepare themselves for the clinical situation, with the sacrifice of considerably fewer laboratory animals than would have occurred previously.

Evidence-Based Microsurgical Skills Acquisition Series Part 2: Validated Assessment Instruments—A Systematic Review

“…Programs are changing from time-based to competency-based evaluations. [10][11][12]15,[37][38][39][40] As portrayed in Part 1 of this series, although many microsurgical training models have been described few have been validated. 1 Those that were validated include the highfidelity rat femoral artery model, 5,38 the medium-fidelity nonliving biologics such as chicken 4,23 and pig legs, 41 and low-fidelity models such as an online curriculum, 23 diathermy-tip cleaner pad with sewing needles, 17 porcine eye, 24 rubber pad, 42 practice card, 5 polyurethane card, 4 and silicone tubing.…”

Multiuse of Disposable Microsurgical Instruments as a Cost-Efficient Alternative for Training and Research

“…Combined with the easily available training models such as surgical gloves or the chicken leg model, they provide an affordable and easily available training opportunity. 1,3–5 The disposable instruments were chemically and heat sterilized with standard research devices.…”

“…1,2 Consequently, the acquisition of microsurgery skills is essential to a growing population of residents and researchers but hampered by the costs of training models and instruments.…”

“…1,3–6 However, the high costs of standard microsurgical instruments and their fragility remain challenging for microsurgery training. Recently, disposable microsurgery instruments have been introduced to provide low case-load practices with inexpensive instruments.…”

A Unique Lymphaticovenous Supermicrosurgery Training Curriculum: Reflections on Validation and Competency Thresholds

“…This step is necessary to ensure respect of the principles of 3Rs. 8 A competency level of 100% patency of 5 consecutive anastomoses is required to proceed to the following step. Then, anastomosis on reduced vessels’ diameter (< 0.5 mm) exercises are commenced using the rat inferior epigastric pedicle-free flap model as described by Yamashita et al, 6 to achieve 5 successful patent anastomoses.…”