Supermicrosurgery simulation training program for submillimeter anastomoses in the rat epigastric artery and vein

Zheng, YuanDian; Corvi, John J.; Nicolas, Celine F.; Akelina, Yelena

doi:10.1002/micr.30483

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…Only two studies demonstrated adequate predictive validity for anastomosis. 36,46 Construct validity was evident in two studies (Table 4). 61,63…”

Section: Resultsmentioning

confidence: 94%

“…Afterward, the second screening process generated 38 articles that were incorporated in the qualitative synthesis (Fig. 1) 7,33–67 . Twenty-three articles reported the use of in vivo models (60.5%), 12 used ex vivo models (31.5%), and three used synthetic models (7.9%).…”

Section: Resultsmentioning

confidence: 99%

“…Only two studies demonstrated adequate predictive validity for anastomosis. 36,46 Construct validity was evident in two studies (Table 4). 61,63 Volume 151, Number Two studies implemented chicken leg models for perforator dissection and flap harvest (5.4%, anterolateral thigh and cutaneous perforator flap), 34,48 whereas one model used a chicken wing for vessel dissection and characterization (2.6%) (Table 5).…”

Section: Characteristics Of Studies Describing In Vivo Modelsmentioning

confidence: 95%

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Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Escandón

Ciudad²,

Poore

et al. 2022

Plastic &Amp; Reconstructive Surgery

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ince first described, supermicrosurgery has been broadly accepted and implemented because of a superior and widespread knowledge of the anatomy of perforators and of lymphatic surgery. [1][2][3][4] In fact, the technical considerations and applications of supermicrosurgery are currently incorporated in different fields Background: Supermicrosurgical simulators and experimental models promote test viability, a faster learning curve, technical innovations, and improvements of the surgical dexterities. The authors aimed to present a systematic review and meta-analysis of preclinical experimental models and simulation platforms used for supermicrosurgery. Methods: An electronic search was conducted across the PubMed MEDLINE, Embase, Web of Science, and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data collection included the types of experimental models and outcomes. Pooled estimates were calculated with a random-effect meta-analysis using the DerSimonian-Laird model. Results: Thirty-eight articles were incorporated in the qualitative synthesis. Twenty-three articles reported the use of in vivo models (60.5%), 12 used ex vivo models (31.5%), and three used synthetic models (7.9%). The superficial inferior epigastric system of rats was the most common in vivo model, whereas chicken wings and hindlimbs were the most common methods used in ex vivo models. The most common methods to evaluate patency of anastomoses were gross inspection, passage of nylon thread into the lumen, and intravascular flow of an injected dye. Nineteen studies were incorporated in the meta-analysis. The overall rate of a successful anastomosis was 94.9% (95% CI, 92.3 to 97.5%). The success rate of in vivo models using rats was 92.5% (95% CI, 88.8 to 96.3%). The success rate of ex vivo models was 97.7% (95% CI, 94.6 to >99%). Conclusion: Simulators that have high fidelity concerning the dissection of the vascular pedicle, flap elevation, supermicrovascular anastomosis, and adequate assessment of a successful anastomosis possess adequate predictive validation to evaluate and simulate the supermicrosurgical technique. (Plast. Reconstr. Surg. 151: 775e, 2023) Clinical Relevance Statement: Supermicrosurgical simulators are designed to reproduce specific clinical scenarios; therefore, these should be implemented sequentially to develop specific competencies. Supermicrosurgical models must be regarded as mutually inclusive learning platforms to optimize the learning curve.

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“…Only two studies demonstrated adequate predictive validity for anastomosis. 36,46 Construct validity was evident in two studies (Table 4). 61,63…”

Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Studies Describing In Vivo Modelsmentioning

confidence: 95%

See 1 more Smart Citation

Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Escandón

Ciudad²,

Poore

et al. 2022

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…A bypass graft from the contralateral leg SIEA can be looped to the recipient SIEA with double end-to-side anastomosis. Training with such small vessels fine tune the trainee's skills and increase their experience with supermicrosurgery to be utilized clinically as the diameter of both the SIEA and SIEV capture the character of a human lymphatic vessel or other small vessels [19]. [6].…”

Section: Supermicrosurgerymentioning

confidence: 99%

Microsurgical education in the USA: Past, present and future

et al. 2021

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Microsurgery is a demanding surgical skillset which requires attention to detail and repeated practice to succeed. Microsurgery courses around the globe allow students to learn through performing a variety of technical exercises. Microsurgery education dates back to the late 1960s with notable instructors, Harry J. Buncke and Robert Acland. Currently, many microsurgery courses are available that share commonalities, and some important structural differences have been demonstrated to differentially affect student progression and competence. Multiple available training programs as well as the advancement of supermicrosurgery training is listed and described.The microsurgery training course at Columbia University’s New York Presbyterian Irving Medical Center led by Drs. Ronsenwasser, Strauch and Akelina provides students with expert instruction through a punctilious training curriculum. By imparting these techniques to the students, trainees’s progression markedly improves relative to alternative microsurgery courses that do not incorporate expert instruction. The Covid-19 pandemic, has resulted in the development of a virtual microsurgery training program at the lab which focuses on building the foundation of basic skills for trainees unable to travel or receive adequate education.

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“…While many excellent surgical training models exist, few have been described for supermicrosurgery. [5][6][7][8] The University of Wisconsin "blue-blood" chicken thigh model -a perfused chicken thigh using blue colored saline-serves as…”

mentioning

confidence: 99%

Augmentation of Chicken Thigh Model with Fluorescence Imaging Allows for Real-Time, High Fidelity Assessment in Supermicrosurgery Training

Albano

Zeng

Lin

et al. 2020

J Reconstr Microsurg

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Background The skills required for supermicrosurgery are hard-earned and difficult to master. The University of Wisconsin “blue-blood” chicken thigh model incorporates perfusion of the thigh vessels with a blue liquid solution, allowing users to visualize flow across their anastomoses. This model has proven to be an excellent source of small vessels (down to 0.3 mm) but assessing the quality of anastomoses at this spatial scale has proven difficult. We evaluated whether fluorescent imaging with indocyanine green (ICG) in this realistic training model would enhance the assessment of supermicrosurgical anastomoses, and therefore improve real-time feedback to trainees. Methods Anastomoses of vessels ranging from 0.35 to 0.55mm in diameter were performed followed by the capture of white light with and without fluorescence imaging overlay during infusion of “blue-blood” and ICG. Videos were randomized and shown to seven fellowship-trained microsurgeons at the University of Wisconsin-Madison who rated each anastomosis as “patent,” “not patent,” or “unsure.” Surgeon accuracy, uncertainty, and inter-rater agreement were measured for each imaging modality. Results Use of fluorescence significantly increased surgeon accuracy to 91% compared with 47% with white light alone (p = 0.015), decreased surgeon uncertainty to 4% compared with 41% with white light alone (p = 0.011), and improved inter-rater agreement from 53.1% with white light alone to 91.8% (p = 0.016). Conclusion Augmentation of the University of Wisconsin “blue-blood” chicken thigh model with ICG fluorescence improves accuracy, decreases uncertainty, and improves inter-rater agreement when assessing supermicrosurgical anastomoses in a training setting. This improved, real-time feedback enhances this model's value as a supermicrosurgical training tool.

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Supermicrosurgery simulation training program for submillimeter anastomoses in the rat epigastric artery and vein

Cited by 5 publications

References 5 publications

Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Microsurgical education in the USA: Past, present and future

Augmentation of Chicken Thigh Model with Fluorescence Imaging Allows for Real-Time, High Fidelity Assessment in Supermicrosurgery Training

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