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Sadigh Y, Mechri I, Jain A, Gautam AT, Seh H, Volovici V. Validation of Novel Microsurgical Vessel Anastomosis Techniques: A Systematic Review. J Reconstr Microsurg 2024. [PMID: 38593990 DOI: 10.1055/a-2302-7126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Thorough validation of novel microsurgical techniques is deemed essential before their integration into clinical practice. To achieve proper validation, the design of randomized controlled trials (RCTs) should be undertaken, accompanied by the execution of comprehensive statistical analyses, including confounder adjustment and power analysis. This systematic review aims to provide an encompassing overview of the validation methodologies employed in microsurgical studies, with a specific focus on innovative vessel anastomosis techniques. METHODS A literature search was conducted in PubMed for articles describing the validation of novel microsurgical vessel anastomosis techniques in animal or human subjects. RESULTS The literature search yielded 6,658 articles. A total of 6,564 articles were excluded based on title and abstract. Ninety-four articles were assessed for full-text eligibility. Forty-eight articles were included in this systematic review. Out of 30 comparative studies, 9 studies validated novel modified interrupted suture techniques, 6 studies modified continuous techniques, 6 studies modified sleeve anastomosis techniques, 1 study a modified vesselotomy technique, 7 studies sutureless techniques, and 1 study a modified lymphaticovenular anastomosis technique. Twenty-eight studies contained animals (n = 1,998). Fifteen animal studies were RCTs. Two studies contained human/cadaveric subjects (n = 29). Statistical power analysis and confounder adjustment were performed in one animal study. Out of 18 noncomparative studies, 5 studies validated novel modified interrupted suture techniques, 1 study a modified continuous technique, 2 studies modified sleeve anastomosis techniques, 4 studies modified vesselotomy techniques, 4 studies sutureless techniques, and 2 studies modified lymphaticovenular anastomosis techniques. Ten studies contained animal subjects (n = 320), with two RCTs. Eight studies contained human subjects (n = 173). Statistical power analysis and confounder adjustment were performed in none of the animal or human studies. CONCLUSION The current methods of microsurgical technique validation should be reconsidered due to poor study design. Statistical analysis including confounder adjustment and power analysis should be performed as a standard method of novel technique validation.
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Affiliation(s)
- Yasmin Sadigh
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Imen Mechri
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Neurosurgery, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Anamika Jain
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Neurosurgery, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Amata Thongphetsavong Gautam
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Hadil Seh
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Neurosurgery, Soroka Medical Center, Beer Sheva, Israel
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Public Health, Centre for Medical Decision Science, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Dun H, Ye L, Zhu Y, Wong BW. Combined abdominal heterotopic heart and aorta transplant model in mice. PLoS One 2020; 15:e0230649. [PMID: 32569305 PMCID: PMC7307752 DOI: 10.1371/journal.pone.0230649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/04/2020] [Indexed: 01/06/2023] Open
Abstract
Background Allograft vasculopathy (AV) remains a major obstacle to long-term allograft survival. While the mouse aortic transplantation model has been proven as a useful tool for study of the pathogenesis of AV, simultaneous transplantation of the aorta alongside the transplantation of another organ may reveal more clinically relevant mechanisms that contribute to the pathogenesis of chronic allograft rejection. Therefore, we developed a combined abdominal heart and aorta transplantation model in mice which benefits from reducing animal and drug utilization, while providing an improved model to study the progressive nature of AV. Methods The middle of the infrarenal aorta of the recipient mouse was ligatured between the renal artery and its bifurcation. Proximal and distal aortotomies were performed at this site above and below the ligature, respectively, for the subsequent anastomoses of the donor aorta and heart grafts to the recipient infrarenal aorta in an end-to-side fashion. The distal anastomotic site of the recipient infrarenal aorta was connected with the outlet of the donor aorta. Uniquely, the proximal anastomotic site on the recipient infrarenal aorta was shared to connect with both the inlet of the donor aorta and the inflow tract to the donor heart. The outflow tract from the donor heart was connected to the recipient inferior vena cava (IVC). Results The median times for harvesting the heart graft, aorta graft, recipient preparation and anastomosis were 11.5, 8.0, 9.0 and 40.5 min, respectively, resulting in a total median ischemic time of 70 min. The surgery survival rate was more than 96% (29/30). Both the syngeneic C57Bl/6 aorta and heart grafts survived more than 90 days in 29 C57Bl/6 recipients. Further, Balb/c to C57Bl/6 allografts treated with anti-CD40L and CTLA4.Ig survived more than 90 days with a 100% (3/3) survival rate. (3/3). Conclusions This model is presented as a new tool for researchers to investigate transplant immunology and assess immunosuppressive strategies. It is possible to share a common anastomotic stoma on the recipient abdominal aorta to reconstruct both the aorta graft entrance and heart graft inflow tract. This allows for the study of allogeneic effects on both the aorta and heart from the same animal in a single survival surgery.
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Affiliation(s)
- Hao Dun
- Laboratory of Lymphatic Metabolism + Epigenetics, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Li Ye
- Laboratory of Lymphatic Metabolism + Epigenetics, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Yuehui Zhu
- Laboratory of Lymphatic Metabolism + Epigenetics, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Brian W. Wong
- Laboratory of Lymphatic Metabolism + Epigenetics, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
- * E-mail:
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Westhofen S, Jelinek M, Dreher L, Biermann D, Martin J, Vitzhum H, Reichenspurner H, Ehmke H, Schwoerer AP. The heterotopic heart transplantation in mice as a small animal model to study mechanical unloading - Establishment of the procedure, perioperative management and postoperative scoring. PLoS One 2019; 14:e0214513. [PMID: 30978185 PMCID: PMC6461225 DOI: 10.1371/journal.pone.0214513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 03/14/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Unloading of failing hearts by left ventricular assist devices induces an extensive cardiac remodeling which may lead to a reversal of the initial phenotype-or to its deterioration. The mechanisms underlying these processes are unclear. HYPOTHESIS Heterotopic heart transplantion (hHTX) is an accepted model for the study of mechanical unloading in rodents. The wide variety of genetically modified strains in mice provides an unique opportunity to examine remodeling pathways. However, the procedure is technically demanding and has not been extensively used in this area. To support investigators adopting this method, we present our experience establishing the abdominal hHTX in mice and describe refinements to the technique. METHODS In this model, the transplanted heart is vascularised but implanted in series, and therefore does not contribute to systemic circulation and results in a complete mechanical unloading of the donor heart. Training followed a systematic program using a combination of literature, video tutorials, cadaveric training, direct observation and training in live animals. RESULTS Successful transplantation was defined as a recipient surviving > 24 hours with a palpable, beating apex in the transplanted heart and was achieved after 20 transplants in live animals. A success rate of 90% was reached after 60 transplants. Operative time was shown to decrease in correlation with increasing number of procedures from 200 minutes to 45 minutes after 60 operations. Cold/warm ischemia time improved from 45/100 to 10/20 minutes. Key factors for success and trouble shootings were identified. CONCLUSION Abdominal hHTX in the mouse may enable future examination of specific pathways in unloading induced myocardial remodeling. Establishment of the technique, however, is challenging. Structured training programs utilising a variety of training methods can help to expedite the process. Postoperative management, including daily scoring increases animal wellbeing and helps to predict survival.
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Affiliation(s)
- Sumi Westhofen
- Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- * E-mail:
| | - Marisa Jelinek
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cellular and Integrative Physiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Leonie Dreher
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cellular and Integrative Physiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Daniel Biermann
- Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Jack Martin
- Department of Surgery, Addenbrookes Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Helga Vitzhum
- Department of Cellular and Integrative Physiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Heimo Ehmke
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cellular and Integrative Physiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Alexander Peter Schwoerer
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cellular and Integrative Physiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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T2 Mapping for Noninvasive Assessment of Interstitial Edema in Acute Cardiac Allograft Rejection in a Mouse Model of Heterotopic Heart Transplantation. Invest Radiol 2018; 53:271-277. [DOI: 10.1097/rli.0000000000000438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
It is now over forty years since this technique was first reported by Corry, Wynn and Russell. Although it took some years for other labs to become proficient in and utilize this technique, it is now widely used by many laboratories around the world. A significant refinement to the original technique was developed and reported in 2001 by Niimi. Described here are the techniques that have evolved over more than a decade in the hands of three surgeons (Plenter, Grazia, Pietra) in our center. These techniques are now being passed on to a younger generation of surgeons and researchers. Based largely on the Niimi experience, the procedures used have evolved in the fine details - details which we will endeavor to relate here in such a way that others may be able to use this very useful model. Like Niimi, we have found that a video aid to learning is a priceless resource for the beginner.
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Affiliation(s)
- Robert J Plenter
- Colorado Center for Transplantation Care, Research and Education and Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver;
| | - Todd J Grazia
- Colorado Center for Transplantation Care, Research and Education and Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver
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Liu X, Song P, Tian J, Zhou S, Yan S, Tan Z, Haller H, Rong S. A simple novel technique for heterotopic intestinal transplantation in mice. Transplant Proc 2012; 45:654-8. [PMID: 23267791 DOI: 10.1016/j.transproceed.2012.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/06/2012] [Indexed: 11/16/2022]
Abstract
The murine heterotopic intestinal transplant model is of particular value for addressing the unique immune response in the gut and addressing the underlying immune mechanism during transplantation. Anastomotic stenosis, anastomotic bleeding, and septic shock continue to hamper procedures and plague the success. In this study, we assessed a refined technique designed to improve the success of heterotopic intestinal transplant in mice. Important factors in our refined technique included (1) a refined procedure for graft portal vein preparation, (2) a novel procedure for graft exteriorization, and most importantly (3) a knotless suturing technique designed to allow the surgeon to alter the size of the anastomosis, thus reducing anastomotic bleeding and stenosis rate. Our refined knotless method improved recipient survival to 67.5% when compared to the standard technique (53.8%). In comparison to standard knot suturing technique, which had an anastomotic stenosis rate of 8.3%, the knotless suturing technique significantly reduced the rate of anastomotic stenosis to only 2.4%. Anastomotic bleeding presented in the knotless technique in only 1.2%, whereas it presented in 6.2%, of mice in the standard technique (P < .05). This refined knotless technique offers an easy and effective method for murine heterotopic intestinal transplantation.
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MESH Headings
- Anastomosis, Surgical
- Animals
- Aorta, Abdominal/surgery
- Blood Loss, Surgical/prevention & control
- Female
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/prevention & control
- Graft Rejection/etiology
- Graft Rejection/prevention & control
- Jejunum/transplantation
- Male
- Mesenteric Artery, Superior/surgery
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Organ Transplantation/adverse effects
- Organ Transplantation/methods
- Portal Vein/surgery
- Suture Techniques
- Transplantation, Heterotopic
- Vascular Grafting/adverse effects
- Vena Cava, Inferior/surgery
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Affiliation(s)
- X Liu
- Department of Gastroenterological Surgery, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, China.
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