Escandón Joseph M, Ciudad Pedro, Poore Samuel O, Mayer Horacio F, Saha Shivangi, Morrison Clinton S, Langstein Howard N, Manrique Oscar J
From the Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center.
Department of Plastic and Reconstructive Surgery, Archbishop Loayza National Hospital.
Plast Reconstr Surg. 2023 May 1;151(5):775e-803e. doi: 10.1097/PRS.0000000000010084. Epub 2022 Dec 20.
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.
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.
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%).
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.
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.
超显微手术模拟器和实验模型可提高测试可行性、加快学习曲线、推动技术创新并改善手术操作技巧。作者旨在对用于超显微手术的临床前实验模型和模拟平台进行系统综述和荟萃分析。
根据系统综述和荟萃分析的首选报告项目声明，在PubMed MEDLINE、Embase、Web of Science和Scopus数据库中进行电子检索。数据收集包括实验模型的类型和结果。使用DerSimonian-Laird模型通过随机效应荟萃分析计算合并估计值。
38篇文章纳入定性综合分析。23篇文章报告使用体内模型（60.5%），12篇使用体外模型（31.5%），3篇使用合成模型（7.9%）。大鼠腹壁浅静脉系统是最常见的体内模型，而鸡翅和后肢是体外模型中最常用的方法。评估吻合口通畅性最常用的方法是大体检查、尼龙线通过管腔以及注入染料的血管内流动。19项研究纳入荟萃分析。吻合成功的总体率为94.9%（95%CI，92.3至97.5%）。使用大鼠的体内模型成功率为92.5%（95%CI，88.8至96.3%）。体外模型的成功率为97.7%（95%CI，94.6至>99%）。
在血管蒂解剖、皮瓣掀起、超微血管吻合以及对吻合成功进行充分评估方面具有高保真度的模拟器具有足够的预测效度，可用于评估和模拟超显微手术技术。
超显微手术模拟器旨在重现特定临床场景；因此，应按顺序实施这些模拟器以培养特定能力。超显微手术模型必须被视为相互包容的学习平台，以优化学习曲线。
