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De Schlichting E, Zaldivar-Jolissaint JF, Molter N, Chenevas-Paule M, Hamadmad A, Giroux L, Lazard A, Riethmuller D, Chaffanjon P, Coll G, Lechanoine F. A Comprehensive Training Model for Simulation of Intracranial Aneurysm Surgery Using a Human Placenta and a Cadaveric Head. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01243. [PMID: 38967445 DOI: 10.1227/ons.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/11/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Aneurysmal surgery is technically complex, and surgeon experience is an important factor in therapeutic success, but training young vascular neurosurgeons has become a complex paradigm. Despite new technologies and simulation models, cadaveric studies still offer an incomparable training tool with perfect anatomic accuracy, especially in neurosurgery. The use of human placenta for learning and improving microsurgical skills has been previously described. In this article, we present a comprehensive simulation model with both realistic craniotomy exposure and vascular handling consisting of a previously prepared and perfused human placenta encased in a human cadaveric specimen. METHODS Humans' placentas from the maternity and cadaveric heads from the body donation program of the anatomy laboratory were used. Placentas were prepared according to the established protocol, and aneurysms were created by catheterization of a placental artery. Ten participants, including senior residents or young attendees, completed an evaluation questionnaire after completing the simulation of conventional unruptured middle artery aneurysm clipping surgery from opening to closure. RESULTS The skin incision, muscle dissection, and craniotomy were assessed as very similar to reality. Brain tissue emulation and dissection of the lateral fissure were judged to be less realistic. Vascular management was evaluated as similar to reality as closure. Participants uniformly agreed that this method could be implemented as a standard part of their training. CONCLUSION This model could provide a good model for unruptured aneurysm clipping training.
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Affiliation(s)
- Emmanuel De Schlichting
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | | | | | | | | | - Luc Giroux
- Université de Grenoble Alpes, Grenoble, France
| | - Arnaud Lazard
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
- Université de Grenoble Alpes, Grenoble, France
- Laboratoire d'Anatomie Des Alpes Françaises (LADAF), Université de Grenoble Alpes, Grenoble, France
| | - Didier Riethmuller
- Université de Grenoble Alpes, Grenoble, France
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | - Philippe Chaffanjon
- Université de Grenoble Alpes, Grenoble, France
- Laboratoire d'Anatomie Des Alpes Françaises (LADAF), Université de Grenoble Alpes, Grenoble, France
- Service de Chirurgie Thoracique, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | - Guillaume Coll
- Service de Neurochirurgie, Centre hospitalier universitaire Gabriel Montpied, Clermont Ferrand, France
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D’Andrea M, Musio A, Colasanti R, Mongardi L, Fuschillo D, Lofrese G, Tosatto L. A novel, reusable, realistic neurosurgical training simulator for cerebrovascular bypass surgery: Iatrotek ® bypass simulator validation study and literature review. Front Surg 2023; 10:1048083. [PMID: 36843992 PMCID: PMC9947354 DOI: 10.3389/fsurg.2023.1048083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Background Microanastomosis is a challenging technique requiring continuous training to be mastered. Several models have been proposed, but few effectively reflect a real bypass surgery; even fewer are reusable, most are not easily accessible, and the setting is often quite long. We aim to validate a simplified, ready-to-use, reusable, ergonomic bypass simulator. Methods Twelve novice and two expert neurosurgeons completed eight End-to-End (EE), eight End-to-Side (ES), and eight Side-to-Side (SS) microanastomoses using 2-mm synthetic vessels. Data on time to perform bypass (TPB), number of sutures and time required to stop potential leaks were collected. After the last training, participants completed a Likert Like Survey for bypass simulator evaluation. Each participant was assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT). Results When comparing the first and last attempts, an improvement of the mean TPB was registered in both groups for the three types of microanastomosis. The improvement was always statistically significant in the novice group, while in the expert group, it was only significant for ES bypass. The NOMAT score improved in both groups, displaying statistical significance in the novices for EE bypass. The mean number of leakages, and the relative time for their resolution, also tended to progressively reduce in both groups by increasing the attempts. The Likert score expressed by the experts was slightly higher (25 vs. 24.58 by the novices). Conclusions Our proposed bypass training model may represent a simplified, ready-to-use, reusable, ergonomic, and efficient system to improve eye-hand coordination and dexterity in performing microanastomoses.
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Affiliation(s)
- Marcello D’Andrea
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Antonio Musio
- Department of Ferrara – Neurosurgery, Sant ‘Anna University Hospital, Ferrara, Italy,Correspondence: Antonio Musio
| | | | - Lorenzo Mongardi
- Department of Ferrara – Neurosurgery, Sant ‘Anna University Hospital, Ferrara, Italy
| | - Dalila Fuschillo
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Giorgio Lofrese
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
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Campos MEC, de Oliveira MMR, Reis AB, de Assis LB, Iremashvili V. Development and validation a task-specific checklist for a microsurgical varicocelectomy simulation model. Int Braz J Urol 2020; 46:796-802. [PMID: 32539251 PMCID: PMC7822372 DOI: 10.1590/s1677-5538.ibju.2019.0571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/18/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To develop and validate a new test of specific technical skills required for microsurgical varicocelectomy. MATERIALS AND METHODS An electronic questionnaire was sent to 558 members of the Brazilian Society of Urology for the validation of the task-specific checklist (TSC) for assessment of microsurgical varicocelectomy. Participants who had experience in this procedure were selected as judges. For construct validation, 12 participants including attending urologists and urological residents in training were recruited for voluntary participation. We formed a group of three experts and a group of nine novices, who had to perform the steps of microsurgical varicocelectomy on a simulation model using human placenta. Each participant was filmed and two blinded raters would then evaluate their performance using the TSC of microsurgical varicocelectomy. RESULTS 14 judges were recruited. The assessment tool was reformulated, according to the judges suggestions and had the content validity achieved. The final version of the TSC was comprised of the task-specific score, a series of 4 items scored in a binary fashion designed for microscopic sub-inguinal varicocelectomy. The differences between the performance of participants with different levels of experience reflected the construct validity. The reliability between the raters was high. The mean time required to complete the training of microsurgical varicocelectomy in simulation model was significantly shorter for experts compared to novices (201 vs. 496 seconds, p=0.01). CONCLUSIONS This preliminary study suggests that the task-specific checklist of microsurgical varicocelectomy is reliable and valid in assessing microsurgical skills.
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Affiliation(s)
| | | | - Augusto Barbosa Reis
- Departamento de Cirurgia, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brasil
| | | | - Viacheslav Iremashvili
- Department of Urology, United Hospital Center, Bridgeport, West Virginia, USA, United States
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4
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Silicone-based simulation models for peripheral nerve microsurgery. J Plast Reconstr Aesthet Surg 2018; 72:477-483. [PMID: 30487050 DOI: 10.1016/j.bjps.2018.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/12/2018] [Accepted: 10/28/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a need for a peripheral nerve model on which surgeons-in-training can simulate the repair of nerve injuries at their own pace. Although practicing on animal models/cadavers is considered the "gold standard" of microsurgical training, the proposed model aims to provide a platform for improving the technical skills of surgical trainees prior to their practice on cadaver/animal models. In addition, this model has the potential to serve as a standardized test medium for assessing the skill sets of surgeons. METHODS Several formulations of silicone were utilized for the design and fabrication of a model which realizes the hierarchical structure of peripheral nerves. The mechanical properties were characterized via the Universal Testing Machine; the damage caused by the needle on the entry sites was assessed through scanning electron microscopy (SEM). RESULTS Mechanical properties of the formulations of silicone were tested to mimic human peripheral nerves. A formulation with 83.3 wt% silicone oil and 0.1 wt% cotton fiber was chosen to be used as nerve fascicles. Both 83.3 wt% silicone oil with cotton fiber and 66.6 wt% silicone oil without fiber provided a microsuturing response similar to that of epineurium at a wall thickness of 1 mm. SEM also confirmed that the entry of the needle did not introduce significant holes at the microsuturing sites. CONCLUSIONS The proposed peripheral nerve model mimicked human tissues mechanically and cosmetically, and a simulation of the repair of a fifth-degree nerve injury was achieved.
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Berretti G, Colletti G, Parrinello G, Iavarone A, Vannucchi P, Deganello A. Pilot study on microvascular anastomosis: performance and future educational prospects. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 38:304-309. [PMID: 29187756 PMCID: PMC6146574 DOI: 10.14639/0392-100x-1583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/08/2017] [Indexed: 11/23/2022]
Abstract
The introduction of microvascular free flaps has revolutionised modern reconstructive surgery. Unfortunately, access to training opportunities at standardised training courses is limited and expensive. We designed a pilot study on microvascular anastomoses with the aim of verifying if a short course, easily reproducible, could transmit microvascular skills to participants; if the chosen pre-test was predictive of final performance; and if age could influence the outcome. A total of 30 participants (10 students, 10 residents and 10 surgeons) without any previous microvascular experience were instructed and tested during a single 3 to 5 hour course. The two microanastomoses evaluated were the first ever performed by each participant. More than the half of the cohort was able to produce both patent microanastomoses in less than 2 hours; two-thirds of the attempted microanastomoses were patent. The pretest predicted decent scores from poor performances with a sensitivity of 61.5%, specificity of 100%, positive predictive value of 100% and negative predictive value of 40%. Students and residents obtained significantly higher scores than surgeons. Since our course model is short, cost-effective and highly reproducible, it could be introduced and implemented anywhere as an educational prospect for preselecting young residents showing talent and natural predisposition and having ambitions towards microvascular reconstructive surgery.
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Affiliation(s)
- G Berretti
- Department of Surgery and Translational Medicine, University of Florence, Italy
| | - G Colletti
- Maxillofacial Surgery, San Paolo Hospital, University of Milan, Italy
| | - G Parrinello
- Department of Surgery and Translational Medicine, University of Florence, Italy
| | - A Iavarone
- Department of Surgery and Translational Medicine, University of Florence, Italy
| | - P Vannucchi
- Department of Surgery and Translational Medicine, University of Florence, Italy
| | - A Deganello
- Department of Surgery and Translational Medicine, University of Florence, Italy
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Belykh E, Lei T, Safavi-Abbasi S, Yagmurlu K, Almefty RO, Sun H, Almefty KK, Belykh O, Byvaltsev VA, Spetzler RF, Nakaji P, Preul MC. Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study. J Neurosurg 2016; 125:915-928. [DOI: 10.3171/2015.8.jns151346] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE
Microvascular anastomosis is a basic neurosurgical technique that should be mastered in the laboratory. Human and bovine placentas have been proposed as convenient surgical practice models; however, the histologic characteristics of these tissues have not been compared with human cerebral vessels, and the models have not been validated as simulation training models. In this study, the authors assessed the construct, face, and content validities of microvascular bypass simulation models that used human and bovine placental vessels.
METHODS
The characteristics of vessel segments from 30 human and 10 bovine placentas were assessed anatomically and histologically. Microvascular bypasses were performed on the placenta models according to a delineated training module by “trained” participants (10 practicing neurosurgeons and 7 residents with microsurgical experience) and “untrained” participants (10 medical students and 3 residents without experience). Anastomosis performance and impressions of the model were assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT) scale and a posttraining survey.
RESULTS
Human placental arteries were found to approximate the M2–M4 cerebral and superficial temporal arteries, and bovine placental veins were found to approximate the internal carotid and radial arteries. The mean NOMAT performance score was 37.2 ± 7.0 in the untrained group versus 62.7 ± 6.1 in the trained group (p < 0.01; construct validity). A 50% probability of allocation to either group corresponded to 50 NOMAT points. In the posttraining survey, 16 of 17 of the trained participants (94%) scored the model's replication of real bypass surgery as high, and 16 of 17 (94%) scored the difficulty as “the same” (face validity). All participants, 30 of 30 (100%), answered positively to questions regarding the ability of the model to improve microsurgical technique (content validity).
CONCLUSIONS
Human placental arteries and bovine placental veins are convenient, anatomically relevant, and beneficial models for microneurosurgical training. Microanastomosis simulation using these models has high face, content, and construct validities. A NOMAT score of more than 50 indicated successful performance of the microanastomosis tasks.
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Affiliation(s)
- Evgenii Belykh
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- 2Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology; and
| | - Ting Lei
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sam Safavi-Abbasi
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaan Yagmurlu
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rami O. Almefty
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Hai Sun
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K. Almefty
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Olga Belykh
- 3Irkutsk State Medical University, Irkutsk, Russia
| | - Vadim A. Byvaltsev
- 2Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology; and
- 3Irkutsk State Medical University, Irkutsk, Russia
| | - Robert F. Spetzler
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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7
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Byvaltsev VA, Belykh EG, Konovalov NA. [New simulation technologies in neurosurgery]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:102-107. [PMID: 27331235 DOI: 10.17116/neiro2016802102-107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The article presents a literature review on the current state of simulation technologies in neurosurgery, a brief description of the basic technology and the classification of simulation models, and examples of simulation models and skills simulators used in neurosurgery. Basic models for the development of physical skills, the spectrum of available computer virtual simulators, and their main characteristics are described. It would be instructive to include microneurosurgical training and a cadaver course of neurosurgical approaches in neurosurgery training programs and to extend the use of three-dimensional imaging. Technologies for producing three-dimensional anatomical models and patient-specific computer simulators as well as improvement of tactile feedback systems and display quality of virtual models are promising areas. Continued professional education necessitates further research for assessing the validity and practical use of simulators and physical models.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk Scientific Center of Surgery and Traumatology; Irkutsk Railway Clinical Hospital, Irkutsk, Russia; State Medical University, Irkutsk, Russia; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia
| | - E G Belykh
- Irkutsk Scientific Center of Surgery and Traumatology
| | - N A Konovalov
- N.N. Burdenko Neurosurgery Research Institute, Moscow, Russia
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Oliveira MM, Araujo AB, Nicolato A, Prosdocimi A, Godinho JV, Valle ALM, Santos M, Reis AB, Ferreira MT, Sabbagh A, Gusmao S, Del Maestro R. Face, Content, and Construct Validity of Brain Tumor Microsurgery Simulation Using a Human Placenta Model. Oper Neurosurg (Hagerstown) 2015; 12:61-67. [DOI: 10.1227/neu.0000000000001030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/05/2015] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Brain tumors are complex 3-dimensional lesions. Their resection involves training and the use of the multiple microsurgical techniques available for removal. Simulation models, with haptic and visual realism, may be useful for improving the bimanual technical skills of neurosurgical residents and neurosurgeons, potentially decreasing surgical errors and thus improving patient outcomes.
OBJECTIVE
To describe and assess an ex vivo placental model for brain tumor microsurgery using a simulation tool in neurosurgical psychomotor teaching and assessment.
METHODS
Sixteen human placentas were used in this research project. Intravascular blood remnants were removed by continuous saline solution irrigation of the 2 placental arteries and placental vein. Brain tumors were simulated using silicone injections in the placental stroma. Eight neurosurgeons and 8 neurosurgical residents carried out the resection of simulated tumors using the same surgical instruments and bimanual microsurgical techniques used to perform human brain tumor operations. Face and content validity was assessed using a subjective evaluation based on a 5-point Likert scale. Construct validity was assessed by analyzing the surgical performance of the neurosurgeon and resident groups.
RESULTS
The placenta model simulated brain tumor surgical procedures with high fidelity. Results showed face and content validity. Construct validity was demonstrated by statistically different surgical performances among the evaluated groups.
CONCLUSION
Human placentas are useful haptic models to simulate brain tumor microsurgical removal. Results using this model demonstrate face, content, and construct validity.
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Affiliation(s)
- Marcelo Magaldi Oliveira
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Surgical Skills Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Audrey Beatriz Araujo
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Arthur Nicolato
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andre Prosdocimi
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Joao Victor Godinho
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Luiza Martins Valle
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcilea Santos
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Barbosa Reis
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mauro Tostes Ferreira
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Abulrahman Sabbagh
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sebastiao Gusmao
- Microsurgical Laboratory, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rolando Del Maestro
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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9
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The history of microsurgery in urology. Urology 2015; 85:971-975. [PMID: 25917720 DOI: 10.1016/j.urology.2014.12.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/24/2014] [Accepted: 12/05/2014] [Indexed: 11/20/2022]
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10
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Oliveira Magaldi M, Nicolato A, Godinho JV, Santos M, Prosdocimi A, Malheiros JA, Lei T, Belykh E, Almefty RO, Almefty KK, Preul MC, Spetzler RF, Nakaji P. Human Placenta Aneurysm Model for Training Neurosurgeons in Vascular Microsurgery. Oper Neurosurg (Hagerstown) 2014; 10 Suppl 4:592-600; discussion 600-1. [DOI: 10.1227/neu.0000000000000553] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Neurosurgery, a demanding specialty, involves many microsurgical procedures that require complex skills, including open surgical treatment of intracranial aneurysms. Simulation or practice models may be useful for acquiring these skills before trainees perform surgery on human patients.
OBJECTIVE:
To describe a human placenta model for the creation and clipping of aneurysms.
METHODS:
Placental vessels from 40 human placentas that were dimensionally comparable to the sizes of appropriate cerebral vessels were isolated to create aneurysms of different shapes. The placentas were then prepared for vascular microsurgery exercises. Sylvian fissure--like dissection technique and clipping of large- and small-necked aneurysms were practiced on human placentas with and without pulsatile flow. A surgical field designed to resemble a real craniotomy was reproduced in the model.
RESULTS:
The human placenta has a plethora of vessels that are of the proper dimensions to allow the creation of aneurysms with dome and neck dimensions similar to those of human saccular and fusiform cerebral aneurysms. These anatomic scenarios allowed aneurysm inspection, manipulation, and clipping practice. Technical microsurgical procedures include simulation of sylvian fissure dissection, unruptured aneurysm clipping, ruptured aneurysm clipping, and wrapping; all were reproduced with high fidelity to the haptics of live human surgery. Skill-training exercises realistically reproduced aneurysm clipping.
CONCLUSION:
Human placenta provides an inexpensive, widely available, convenient biological tissue that can be used to create models of cerebral aneurysms of different morphologies. Neurosurgical trainees may benefit from the preoperative use of a realistic model to gain familiarity and practice with critical surgical techniques for treating aneurysms.
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Affiliation(s)
| | | | - Joao V. Godinho
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Andre Prosdocimi
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Ting Lei
- Neurosurgery Research Laboratory and
| | | | - Rami O. Almefty
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K. Almefty
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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11
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The human umbilical cord: a model for microsurgical training. J Hand Microsurg 2014; 6:110-2. [PMID: 25414564 DOI: 10.1007/s12593-014-0142-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022] Open
Abstract
Microsurgery continues to be a fundamental technique in many surgical subspecialties. In the past, many models have been utilized for microsurgery training. We are proposing the human umbilical cord as a training model, which is cheap, available and practical. This model can be used both for junior trainees to achieve good microsurgical skills before operating on human being and it can also help surgeons to maintain their skills.
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12
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Lannon DA, Atkins JA, Butler PE. Non-vital, prosthetic, and virtual reality models of microsurgical training. Microsurgery 2002; 21:389-93. [PMID: 11757067 DOI: 10.1002/micr.21709] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many microsurgical training models exist. These can be broadly classified into living and non-living. The latter type can be further sub-classified into non-vital, prosthetic, and virtual reality models. We review each model within these sub-groups with reference to the ideal properties of a training model. The most important attribute of any model is that the skills acquired from it must translate efficiently into microsurgical skill in the clinical situation. We believe that non-vital and prosthetic models are an important complement to living ones in training and maintaining the skills of all microsurgeons. As virtual reality technology improves, virtual models may succeed the rat as the microsurgical training tool of choice.
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Affiliation(s)
- D A Lannon
- Department of Plastic Surgery, The Royal Free Hospital, Pond Street, Hampstead, London NW3, United Kingdom
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13
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Li PS, Schlegel PN, Goldstein M. Use of silicone medical grade tubing for microsurgical vasovasostomy training. Urology 1992; 39:556-7. [PMID: 1615608 DOI: 10.1016/0090-4295(92)90017-q] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- P S Li
- Male Reproduction and Microsurgery Unit, James Buchanan Brady Foundation, New York Hospital-Cornell Medical Center
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14
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Steffens K, Koob E, Hong G. Training in basic microsurgical techniques without experiments involving animals. Arch Orthop Trauma Surg 1992; 111:198-203. [PMID: 1622708 DOI: 10.1007/bf00571477] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Until recently, anaesthetised rats have been the usual material employed for learning basic microvascular and microneurosurgical techniques. However, ethical considerations, the costs involved and legislation controlling experiments with animals allow training in microsurgery for extended periods of time at a few medical centres only. This paper reports on our experience of an alternative training programme largely conducted without using live animals. As the basic material we selected legs of slaughtered pigs. According to the developing skill of the trainee, basic microsurgical techniques can be practised on arteries and veins of various sizes in these legs. To verify positive results, the vessels are subsequently perfused with human blood under pressure. The model described is particularly suited to the acquiring of skills in microneurosurgery. Mono-, oligo- and polyfascicular nerves, structurally similar to the configurations found in human extremities, are found in pig legs. The ever-increasing importance of microsurgery in modern medicine requires more and more surgeons and orthopaedists to familiarize themselves with these techniques. The model we propose for teaching and training substantially facilitate such further professional training in an efficient way, and at the same time allows a substantial reduction in the number of experiments conducted on animals.
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Affiliation(s)
- K Steffens
- Klinik für Hand- und Plastische Chirurgie, St. Josef-Hospitals Essen-Kupferdreh, Federal Republic of Germany
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Abstract
Regular exercises in microsurgery are mandatory for the microsurgeon to develop and maintain skill. Not all microsurgeons have access to a hospital or university laboratory in which to perform such microsurgical procedures. The authors describe a simple model for a portable microvascular laboratory that can be set up in an office.
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