Department of Experimental Microsurgery, Center for Surgical Simulation, Training and Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Department of Surgery, First Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
J Reconstr Microsurg. 2022 Oct;38(8):604-612. doi: 10.1055/s-0042-1750422. Epub 2022 Jul 7.
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.
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.
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, < 0.001 for noninferiority.
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.
几十年来，活体动物一直被用作开发手术技能的众多训练模型之一。特别是显微外科手术依赖于培训来获得和维持技能，使用活体动物模型，尤其是老鼠（鼠模型）。正在努力减少为实现这一目标而牺牲的老鼠数量。
一组具有最低显微外科经验的学生，在完成基础显微外科课程后，被随机分为三组，三组均遵循基于低和中保真度训练模型的 24 周标准训练计划，并设有标准化的鼠类训练日。除了标准的训练方案外，每个参与者每隔 4、6 或 8 周在活体老鼠身上进行补充训练。根据训练方案，程序在鸡腿、花瓣和老鼠上进行，每个程序均使用经过验证的模型和量表进行盲法评估和评估。主要评估结果是每组最后一次大鼠吻合术的斯坦福显微外科和住院医师培训（SMaRT）量表结果，检验假设为非劣效性。次要结果由最后一次大鼠吻合时间、最后一次鸡腿吻合结果和时间以及最后一次花瓣评分表示。
在第 24 周后，三组之间的显微外科技能没有差异，这可以通过上述手术结果来衡量。所有参与者在研究期间均有显著改善（SMaRT 量表平均[标准差]为 19 ± 4 分），组间无显著差异，<0.001 为非劣效性。
基于低和中保真度模型的训练方案，加上每 8 周对活体大鼠进行一次训练，与每 6 周对活体大鼠进行一次训练和每 4 周对活体大鼠进行一次训练的方案一样非劣效。
