J Reconstr Microsurg 2021; 37(02): 119-123
DOI: 10.1055/s-0040-1714428
Original Article

Novel Porcine Kidney-Based Microsurgery Training Model for Developing Basic to Advanced Microsurgical Skills

Jose Maciel Caldas dos Reis
1   Department of Experimental Surgery, State University of Para Belem, Para, Brazil
,
Renan Kleber Costa Teixeira
1   Department of Experimental Surgery, State University of Para Belem, Para, Brazil
,
Deivid Ramos dos Santos
2   Department of Orthopedic Surgery, State University of Para Belem, Para, Brazil
,
Faustino Chaves Calvo
1   Department of Experimental Surgery, State University of Para Belem, Para, Brazil
,
Nayara Pontes de Araújo
1   Department of Experimental Surgery, State University of Para Belem, Para, Brazil
,
Wender Jesus Pena de Corrêa Junior
1   Department of Experimental Surgery, State University of Para Belem, Para, Brazil
,
Antonio Leonardo Jatahi Cavalcanti Pimentel
1   Department of Experimental Surgery, State University of Para Belem, Para, Brazil
,
Rui Sergio Monteiro de Barros
2   Department of Orthopedic Surgery, State University of Para Belem, Para, Brazil
› Author Affiliations

Abstract

Background Microsurgery training is critical to the practice of microvascular procedures in many surgical areas. However, even simple procedures require different levels of complex skills. Therefore, simulation-based surgical training, mainly in the area of vascular anastomosis, is of great importance. In this paper, we present a new microsurgery training model for the development of basic to advanced microsurgical skills.

Methods Porcine kidneys were purchased from a legal butchery slaughterhouse. First, kidneys were washed with water to remove blood and clots inside vessels. Then, dissection was performed throughout the vascular pedicle from the renal arteries to the segmentary branches. Finally, the longitudinal sectioning of the kidney parenchyma was performed to expose the vessels necessary for training. Sixty end-to-end anastomoses were performed. Specific instruments and materials were used to perform anastomoses and dissections with magnification by a video system. We evaluated the diameter of vessels, time to perform anastomosis, and patency of anastomosis.

Results There was no great anatomical variation among the porcine kidneys. The total length for dissection training was 25.80 ± 7.44 cm using the arterial and venous vessel. The average time to perform arterial anastomoses was 23.79 ± 4.55 minutes. For vessel diameters of ≤ 3, 4 to 6, and 7 to 10 mm, the average procedure times were 27.68 ± 3.39, 22.92 ± 4.12, and 20.77 ± 3.44 minutes, respectively. Regarding venous anastomosis, the average duration of the procedure was 26.17 ± 4.80 minutes, including durations of 31.61 ± 3.86, 25.66 ± 4.19, and 21.24 ± 3.79 minutes for vessel diameters of ≤ 7, 8 to 10, and >10 mm, respectively. Positive patency was achieved in all surgeries.

Conclusion The porcine kidney provides an inexpensive and convenient biological model for modeling microanastomosis with high fidelity to vascular structures.



Publication History

Received: 18 March 2020

Accepted: 16 June 2020

Article published online:
22 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Evgeniou E, Walker H, Gujral S. The role of simulation in microsurgical training. J Surg Educ 2018; 75 (01) 171-181
  • 2 Zyluk A, Szlosser Z, Puchalski P. Undergraduate microsurgical training: a preliminary experience. Handchir Mikrochir Plast Chir 2019; 51 (06) 477-483
  • 3 Olijnyk LD, Patel K, Brandão MR. et al. The role of low-cost microsurgical training models and experience with exercises based on a bovine heart. World Neurosurg 2019; 130: 59-64
  • 4 Ortiz R, Sood RF, Wilkens S, Gottlieb R, Chen NC, Eberlin KR. Longitudinal microsurgery laboratory training during hand surgery fellowship. J Reconstr Microsurg 2019; 35 (09) 640-645
  • 5 Vinagre G, Villa J, Amillo S. Microsurgery training: does it improve surgical skills?. J Hand Microsurg 2017; 9 (01) 47-48
  • 6 Rodriguez JR, Yañez R, Cifuentes I, Varas J, Dagnino B. Microsurgery workout: a novel simulation training curriculum based on nonliving models. Plast Reconstr Surg 2016; 138 (04) 739e-747e
  • 7 Sakamoto Y, Okamoto S, Shimizu K, Araki Y, Hirakawa A, Wakabayashi T. Hands-on simulation versus traditional video-learning in teaching microsurgery technique. Neurol Med Chir (Tokyo) 2017; 57 (05) 238-245
  • 8 Cho MJ, Halani SH, Davis J, Zhang AY. Achieving balance between resident autonomy and patient safety: analysis of resident-led microvascular reconstruction outcomes at a microsurgical training center with an established microsurgical training pathway. J Plast Reconstr Aesthet Surg 2019; S1748–6815 (19) 30353-30355
  • 9 Grahem HD, Teixeira RKC, Feijó DH. et al. Low-cost vascular anastomosis training: the surgeon goes to market. J Vasc Bras 2017; 16 (03) 262-266
  • 10 Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC. The role of laboratory dissection training in neurosurgical residency: results of a national survey. World Neurosurg 2014; 82 (05) 554-559
  • 11 Lahiri A, Lim AY, Qifen Z, Lim BH. Microsurgical skills training: a new concept for simulation of vessel-wall suturing. Microsurgery 2005; 25 (01) 21-24
  • 12 de Oliveira MMR, Ferrarez CE, Ramos TM. et al. Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity. J Neurosurg 2018; 128 (03) 846-852
  • 13 Santos DRD, Calvo FC, Feijó DH, Araújo NP, Teixeira RKC, Yasojima EY. New training model using chickens intestine for pediatric intestinal anastomosis. Acta Cir Bras 2019; 34 (07) e201900709
  • 14 Brown JS, Rapaport BHJ. Role of live animals in the training of microvascular surgery: a systematic review. Br J Oral Maxillofac Surg 2019; 57 (07) 616-619
  • 15 Javid P, Aydın A, Mohanna PN, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: a systematic review. Microsurgery 2019; 39 (07) 655-668
  • 16 Sergio R, de Barros M, Brito MV. et al. A low-cost high-definition video system for microsurgical hindlimb replantation in rats. J Reconstr Microsurg 2017; 33 (03) 158-162
  • 17 de Barros RSM, Brito MVH, de Brito MH. et al. Morphofunctional evaluation of end-to-side neurorrhaphy through video system magnification. J Surg Res 2018; 221: 64-68
  • 18 Yin X, Ye G, Lu J. et al. A novel rat model for comprehensive microvascular training of end-to-end, end-to-side, and side-to-side anastomoses. J Reconstr Microsurg 2019; 35 (07) 499-504
  • 19 Ahmadi I, Herle P, Miller G, Hunter-Smith DJ, Leong J, Rozen WM. End-to-end versus end-to-side microvascular anastomosis: a meta-analysis of free flap outcomes. J Reconstr Microsurg 2017; 33 (06) 402-411
  • 20 Aske KC, Waugh CA. Expanding the 3R principles: more rigour and transparency in research using animals. EMBO Rep 2017; 18 (09) 1490-1492
  • 21 MacRae JM, Oliver M, Clark E. et al. Canadian Society of Nephrology Vascular Access Work Group. Arteriovenous vascular access selection and evaluation. Can J Kidney Health Dis 2016; 3: 2054358116669125
  • 22 Costa AL, Cucinotta F, Fazio A. et al. Anterolateral thigh flap in a chicken model: a novel perforator training model. J Reconstr Microsurg 2019; 35 (07) 485-488
  • 23 Shulzhenko NO, Zeng W, Albano NJ. et al. Multispecialty microsurgical course utilizing the blue-blood chicken thigh model significantly improves resident comfort, confidence, and attitudes in multiple domains. J Reconstr Microsurg 2020; 36 (02) 142-150
  • 24 Carey JN, Rommer E, Sheckter C. et al. Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. J Plast Reconstr Aesthet Surg 2014; 67 (02) e42-e48
  • 25 Cooper L, Sindali K, Srinivasan K, Jones M, Nugent N. Developing a three-layered synthetic microsurgical simulation vessel. J Reconstr Microsurg 2019; 35 (01) 15-21
  • 26 Storz P, Buess GF, Kunert W, Kirschniak A. 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc 2012; 26 (05) 1454-1460