Mokhtari Pooneh, Tayebi Meybodi Ali, Lawton Michael T, Payman Andre, Benet Arnau
Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
World Neurosurg. 2017 Dec;108:230-235. doi: 10.1016/j.wneu.2017.08.132. Epub 2017 Sep 1.
Learning to perform microvascular anastomosis is difficult. Laboratory practice models using artificial vessels are frequently used for this purpose. However, the efficacy of such practice models has not been objectively assessed for the performance of microvascular anastomosis during live surgical settings. This study was conducted to assess the transfer of learning from practicing microvascular anastomosis on tubes to anastomosing rat abdominal aorta.
Ten surgeons without any experience in microvascular anastomosis were randomly assigned to an experimental or a control group. Both groups received didactic and visual training on end-to-end microvascular anastomosis. The experimental group received 24 sessions of hands-on training on microanastomosis using Silastic tubes. Next, both groups underwent recall tests on weeks 1, 2, and 8 after training. The recall test consisted of completing an end-to-end anastomosis on the rat's abdominal aorta. Anastomosis score, the time to complete the anastomosis, and the average time to place 1 stitch on the vessel perimeter were compared between the 2 groups.
Compared with the control group, the experimental group did significantly better in terms of anastomosis score, total time, and per-stitch time. The measured variables showed stability and did not change significantly between the 3 recall tests.
The skill of microvascular anastomosis is transferred from practicing on Silastic tubes to rat's abdominal aorta. Considering the relative advantages of Silastic tubes to live rodent surgeries, such as lower cost and absence of ethical issues, our results support the widespread use of Silastic tubes in training programs for microvascular anastomosis.
学习进行微血管吻合术颇具难度。为此常使用人工血管的实验室实践模型。然而，此类实践模型在实际手术场景中对微血管吻合术操作的有效性尚未得到客观评估。本研究旨在评估从在管子上练习微血管吻合术到吻合大鼠腹主动脉的学习迁移情况。
将10名无微血管吻合术经验的外科医生随机分为实验组和对照组。两组均接受了端端微血管吻合术的理论和可视化培训。实验组接受了24次使用硅橡胶管进行微血管吻合术的实操训练。接下来，两组在训练后的第1周、第2周和第8周进行回顾性测试。回顾性测试包括在大鼠腹主动脉上完成端端吻合术。比较两组之间的吻合术评分、完成吻合术的时间以及在血管周长上放置1针的平均时间。
与对照组相比，实验组在吻合术评分、总时间和每针时间方面表现明显更好。所测量的变量显示出稳定性，在3次回顾性测试之间没有显著变化。
微血管吻合术的技能可从在硅橡胶管上练习迁移至大鼠腹主动脉吻合。考虑到硅橡胶管相对于活体啮齿动物手术的相对优势，如成本较低且不存在伦理问题，我们的结果支持在微血管吻合术培训项目中广泛使用硅橡胶管。
