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

Abstract

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.

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

“…Although several studies demonstrated that the additional time spent exercising on nonliving tissue models improves the acquisition of technical skills in microsurgery, 3 4 5 working on living tissue models remained an important aspect. 2…”

Structured evaluation of a comprehensive microsurgical training program

“…The requirement of live animals for surgical training is of particular interest for many researchers (27)(28)(29). Nevertheless, most surgeons consider that adequate microsurgical training can be completed without live models, and the current effort is to attempt to minimize the use of live animals (30,31). The use of virtual and augmented reality devices will hopefully be a powerful adjunct to microsurgical training, but these tools still require a thorough validation (32).…”

Current trends in microsurgical education – review of types of training and skill assessment instruments

“…They offer the opportunity to practice dissection and perform vascular anastomosis, flaps and finally reconstructions techniques, and organs transplantations. Living models not only provides conditions similar to human tissue but also provide excellent feedback of anastomosis patency [7].…”

“…The chicken thigh model was validated in several studies as it closely reflects arterial anastomosis in the human hand in terms of both -size of the anastomosis and required tissue care [10][11][12]. Furthermore, non-living models are cost-efficient and do not interfere with ethical issues, but provide no feedback about the anastomosis function, blood flow, or tendency to thrombosis [7].…”

“…Validated scales were detailed in (Table 3). Application of prior training with non-living models allowed to reduction of living models between 50% to 90% without compromising the quality of training [7,15].…”