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Sapino G, Gonvers S, Cherubino M, Ballestín A, di Summa PG. Synthetic Simulators for Microsurgery Training: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6004. [PMID: 39071766 PMCID: PMC11281774 DOI: 10.1097/gox.0000000000006004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/31/2024] [Indexed: 07/30/2024]
Abstract
Background Microsurgery has a steep learning curve. Synthetic simulators have proven to be useful training tools for the initial learning stages, as well as being ethically sound, viable, safe, and cost-effective. The objective of this review was to determine the quality, effectiveness, and validity of these simulators as well as to assess their ability to evaluate microsurgical skills. Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. We searched databases (Web of Science, Scopus, and PubMed) to identify original articles describing synthetic training models for microsurgery. Three reviewers evaluated articles for inclusion following predefined selection criteria. Data were extracted from full-texts of included articles. Results Thirty-nine studies met the inclusion criteria. A total of 38 different devices have been recorded. Microsurgical training devices offer a low-cost, fast, and consistent method to concretely quantify and assess the initial microsurgical skills of trainees using standardized exercises that can be scored by the examiner. According to the authors, the outcomes were satisfactory, with a tangible improvement in microsurgical abilities, despite the lack of a common comparison scale. Conclusions Thanks to their availability, cost, and effectiveness, synthetic models are the recommended option to train basic, intermediate and advanced procedures before executing them on in vivo models.
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Affiliation(s)
- Gianluca Sapino
- From the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Stephanie Gonvers
- From the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Mario Cherubino
- Department of Plastic and Hand Surgery, University Hospital of Varese, University of Varese, Varese, Italy
| | - Alberto Ballestín
- Tumor Microenvironment Laboratory, UMR3347 CNRS/U1021 INSERM, Institut Curie, Orsay—Paris, France
| | - Pietro Giovanni di Summa
- From the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
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Liu W, Jiang D, Schulz M, Figueiredo C, Dondossola D, Meister FA, Tihanyi DK, Mehrabi A, Tolba RH, Czigany Z, Ernst L. Machine perfusion of the liver and in vivo animal models: A systematic review of the preclinical research landscape. PLoS One 2024; 19:e0297942. [PMID: 38329986 PMCID: PMC10852327 DOI: 10.1371/journal.pone.0297942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Machine perfusion (MP) is often referred to as one of the most promising advancements in liver transplantation research of the last few decades, with various techniques and modalities being evaluated in preclinical studies using animal models. However, low scientific rigor and subpar reporting standards lead to limited reproducibility and translational potential, hindering progress. This pre-registered systematic review (PROSPERO: CRD42021234667) aimed to provide a thematic overview of the preclinical research landscape on MP in liver transplantation using in vivo transplantation models and to explore methodological and reporting standards, using the ARRIVE (Animal Research: Reporting of In Vivo Experiments) score. In total 56 articles were included. Studies were evenly distributed across Asia, Europe, and the Americas. Porcine models were used in 57.1% of the studies, followed by rats (39.3%) and dogs (3.6%). In terms of graft type, 55.4% of the studies used donation after cardiac death grafts, while donation after brain death grafts accounted for 37.5%. Regarding MP modalities, the distribution was as follows: 41.5% of articles utilized hypothermic MP, 21.5% normothermic MP, 13.8% subnormothermic MP, and 16.9% utilized hypothermic oxygenated MP. The stringent documentation of ARRIVE elements concerning precise experimental execution, group size and selection, the choice of statistical methods, as well as adherence to the principles of the 3Rs, was notably lacking in the majority of publications, with less than 30% providing comprehensive details. Postoperative analgesia and antibiotics treatment were not documented in 82.1% of all included studies. None of the analyzed studies fully adhered to the ARRIVE Guidelines. In conclusion, the present study emphasizes the importance of adhering to reporting standards to promote reproducibility and adequate animal welfare in preclinical studies in machine perfusion. At the same time, it highlights a clear deficiency in this field, underscoring the need for further investigations into animal welfare-related topics.
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Affiliation(s)
- Wenjia Liu
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
- Institute for Laboratory Animal Science and Experimental Surgery, Faculty of Medicine, RWTH, Aachen International University, Aachen, Germany
| | - Decan Jiang
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Mareike Schulz
- Institute for Laboratory Animal Science and Experimental Surgery, Faculty of Medicine, RWTH, Aachen International University, Aachen, Germany
| | - Constança Figueiredo
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Franziska Alexandra Meister
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rene Hany Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, Faculty of Medicine, RWTH, Aachen International University, Aachen, Germany
| | - Zoltan Czigany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Lisa Ernst
- Institute for Laboratory Animal Science and Experimental Surgery, Faculty of Medicine, RWTH, Aachen International University, Aachen, Germany
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Guo H, Wang X, Gao Z, Feng L. The incision can't be sutured after modified radical mastectomy: What else can we do? Asian J Surg 2024; 47:606-608. [PMID: 37805318 DOI: 10.1016/j.asjsur.2023.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Honggang Guo
- Department of Plastic Surgery, Linyi People's Hospital, Shandong Province, China
| | - Xiuxiu Wang
- Second Department of Internal Medicine, Linyi Cancer Hospital, Shandong Province, China
| | - Zhongcheng Gao
- Department of Breast Surgery, Linyi People's Hospital, Shandong Province, China.
| | - Liyong Feng
- Department of Breast Surgery, Linyi People's Hospital, Shandong Province, China.
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Avelar TM, Lovato RM, Barbosa TG, Xander PAW, Rodrigues LHDAS, Campos AJB, Riechelmann RS, Flores JAC, Aguiar GBDE, Oliveira JGDE, Veiga JCE. Evaluation of konjac noodle as a microsurgery training model: learning curve analysis. Rev Col Bras Cir 2023; 50:e20233528. [PMID: 37436283 PMCID: PMC10508674 DOI: 10.1590/0100-6991e-20233528-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND classical models of microsurgical anastomosis training are expensive and have ethical implications. Some alternatives join low cost and easiness to store. However, the translation of knowledge acquired by training in these methods into the traditional ones is not clear. This project aims to assess the feasibility of konjac noodles as a reliable microsurgery-training model. METHODS 10 neurosurgery residents performed an end-to-end anastomosis in a 2-3mm placenta artery. The anastomoses were evaluated quantitatively, recording time; and qualitatively, applying a validated score (Anastomosis Lapse Index - ALI) by three experienced neurosurgeons and verifying the presence of gross leakage through the infusion of fluorescein. Subsequently, they performed 10 non-consecutive sessions of anastomosis training in the konjac noodle. Eventually, a final anastomosis in the placenta model was performed and the same parameters were scored. RESULTS we observed a 17min reduction in the mean time to perform the anastomosis in the placenta model after the training in the konjac (p<0.05). There was a non-significant 20% reduction in gross leakage, but the training sessions were not able to consistently improve the ALI score. CONCLUSIONS we demonstrate a reduction in anastomosis performing time in placental arteries after training sessions in the konjac noodle model, which can be regarded as a feasible low-cost method, particularly useful in centers with surgical microscopes only in the operation room.
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Affiliation(s)
- Tiago Marques Avelar
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | - Renan Maximilian Lovato
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | - Thiago Gomes Barbosa
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | - Paulo Adolfo Wessel Xander
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | | | - Adriana Jose Brito Campos
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | - Ricardo Salemi Riechelmann
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | - Juan Antonio Castro Flores
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | - Guilherme Brasileiro DE Aguiar
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | - Jean Gonçalves DE Oliveira
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
| | - José Carlos Esteves Veiga
- -Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Divisão de Neurocirurgia - São Paulo - SP - Brasil
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Ciudad P, Reynaga C, Aucasi I, Ludeña J, Manrique OJ, Castro J, Rojas D, Llanca L, Escandón JM. Maximizing the use of the distal descending branch of the lateral circumflex femoral artery during donor site closure: An opportunity for learning. J Plast Reconstr Aesthet Surg 2023; 80:165-167. [PMID: 37028243 DOI: 10.1016/j.bjps.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/15/2023] [Indexed: 04/08/2023]
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Klit A, Konge L, Nayahangan LJ, Hesselfeldt-Nielsen J. A national needs assessment to identify technical procedures in plastic surgery for simulation-based training. J Plast Surg Hand Surg 2023; 57:137-144. [PMID: 35034555 DOI: 10.1080/2000656x.2021.2017945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Medical simulation is not developed and integrated into plastic surgery unlike other surgical specialties despite the procedures being complex and require practice. First step in enhancing simulation in plastic surgery is to clarify the need among peers. The objective of the study was to identify and prioritize the technical procedures that should be included in a simulation-based curriculum for residency training in plastic surgery. A panel of participants with key roles in the Danish plastic surgery specialist training program was appointed. Participation was voluntary. A national need assessment study was performed using a three-round Delphi process to collect information from the participants. In round 1, participants reported all the procedures that a newly qualified specialist in plastic surgery should be able to perform. In round 2, participants replied to a survey exploring the frequency of the procedures, the number of surgeons performing the procedure, the risk or discomfort for patients treated by an inexperienced surgeon and the feasibility of training the procedure in simulation, resulting in a preliminary ranking of procedures. In round 3, participants eliminated and reprioritized the identified procedures according to importance. Thirty-five of 37 agreed to enter the expert panel. The response rate was 97%, 86% and 86% for rounds 1, 2 and 3, respectively. Twenty-nine of 136 procedures identified in round 1 reached the final prioritized list of procedures relevant for simulation training in plastic surgery.
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Affiliation(s)
- Anders Klit
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation - CAMES, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation - CAMES, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
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Wlasitsch-Nagy Z, Bálint A, Kőnig-Péter A, Varga P, Várady E, Bogner P, Gasz B. New CFD-based method for morphological and functional assessment in cardiovascular skill training. J Vasc Surg Cases Innov Tech 2022; 8:770-778. [DOI: 10.1016/j.jvscit.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
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An Innovative Simulation Model for Microvascular Training. Plast Reconstr Surg 2022; 150:189e-193e. [PMID: 35767635 DOI: 10.1097/prs.0000000000009209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Preclinical/clinical microsurgical training is essential for clinical practice. Therefore, various training models have been established, such as synthetic and cadaveric models. The most common limitation of these models is the lack of circulation, which limits the simulation of real intraoperative circumstances. Thus, the authors aimed to create a novel model that provides blood circulation with an extracorporeal perfusion device that they attached to rat cadavers for the reestablishment of a circulatory system. Patent blue and heparin were added to the perfusion fluid to visualize circulation and to dissolve thrombosis, and indocyanine green fluorescent imaging was applied to show the perfusion of the entire body. The femoral and brachial vessels were dissected, and an end-to-end anastomosis was performed on the femoral artery. The patency of the operated vessel was visualized with indocyanine green fluorescent imaging. Indocyanine green fluorescent imaging showed appropriate vessel patency and extremity perfusion through the anastomosis. The use of this novel rat model enables a solution for ethical problems encountered when using rats for surgical training courses. By practicing on these animal-sparing models with intact circulation, microsurgical skills can be improved. Future studies on further microsurgical techniques and vascular perfusion of organs or tumors may benefit from our model.
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Szabo B, Gasz B, Fazekas LA, Varga A, Kiss-Papai L, Matolay O, Rezsabek Z, Al-Smadi MW, Nemeth N. Heterogeneous Maturation of Arterio-Venous Fistulas and Loop-Shaped Venous Interposition Grafts: A Histological and 3D Flow Simulation Comparison. Biomedicines 2022; 10:biomedicines10071508. [PMID: 35884813 PMCID: PMC9313372 DOI: 10.3390/biomedicines10071508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/13/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
Vascular graft maturation is associated with blood flow characteristics, such as velocity, pressure, vorticity, and wall shear stress (WSS). Many studies examined these factors separately. We aimed to examine the remodeling of arterio-venous fistulas (AVFs) and loop-shaped venous interposition grafts, together with 3D flow simulation. Thirty male Wistar rats were randomly and equally divided into sham-operated, AVF, and loop-shaped venous graft (Loop) groups, using the femoral and superficial inferior epigastric vessels for anastomoses. Five weeks after surgery, the vessels were removed for histological evaluation, or plastic castings were made and scanned for 3D flow simulation. Remodeling of AVF and looped grafts was complete in 5 weeks. Histology showed heterogeneous morphology depending on the distribution of intraluminal pressure and WSS. In the Loop group, an asymmetrical WSS distribution coincided with the intima hyperplasia spots. The tunica media was enlarged only when both pressure and WSS were high. The 3D flow simulation correlated with the histological findings, identifying “hotspots” for intimal hyperplasia formation, suggesting a predictive value. These observations can be useful for microvascular research and for quality control in microsurgical training.
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Affiliation(s)
- Balazs Szabo
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond u. 22, H-4032 Debrecen, Hungary; (B.S.); (L.A.F.); (A.V.); (Z.R.); (M.W.A.-S.)
| | - Balazs Gasz
- Department of Surgical Research and Techniques, Faculty of Medicine, University of Pecs, Szigeti u. 12, H-7624 Pecs, Hungary; (B.G.); (L.K.-P.)
| | - Laszlo Adam Fazekas
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond u. 22, H-4032 Debrecen, Hungary; (B.S.); (L.A.F.); (A.V.); (Z.R.); (M.W.A.-S.)
| | - Adam Varga
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond u. 22, H-4032 Debrecen, Hungary; (B.S.); (L.A.F.); (A.V.); (Z.R.); (M.W.A.-S.)
| | - Levente Kiss-Papai
- Department of Surgical Research and Techniques, Faculty of Medicine, University of Pecs, Szigeti u. 12, H-7624 Pecs, Hungary; (B.G.); (L.K.-P.)
| | - Orsolya Matolay
- Department of Pathology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4032 Debrecen, Hungary;
| | - Zsofia Rezsabek
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond u. 22, H-4032 Debrecen, Hungary; (B.S.); (L.A.F.); (A.V.); (Z.R.); (M.W.A.-S.)
| | - Mohammad W. Al-Smadi
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond u. 22, H-4032 Debrecen, Hungary; (B.S.); (L.A.F.); (A.V.); (Z.R.); (M.W.A.-S.)
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond u. 22, H-4032 Debrecen, Hungary; (B.S.); (L.A.F.); (A.V.); (Z.R.); (M.W.A.-S.)
- Correspondence: ; Tel./Fax: +36-52-416-915
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Ballestín A, Malzone G, Menichini G, Lucattelli E, Innocenti M. New Robotic System with Wristed Microinstruments Allows Precise Reconstructive Microsurgery: Preclinical Study. Ann Surg Oncol 2022; 29:7859-7867. [PMID: 35727461 DOI: 10.1245/s10434-022-12033-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Microsurgery allows complex reconstruction of tissue defects after oncological resections or severe trauma. Performing these procedures may be limited by human tremor, precision, and manual dexterity. A new robot designed specifically for microsurgery with wristed microinstruments and motion scaling may reduce human tremor and thus enhance precision. This randomized controlled preclinical trial investigated whether this new robotic system can successfully perform microsurgical needle driving, suturing, and anastomosis. METHODS Expert microsurgeons and novices completed six needle passage exercises and performed six anastomoses by hand and six with the new robot. Experienced microsurgeons blindly assessed the quality of the procedures. Precision in microneedle driving and stitch placement was assessed by calculating suturing distances and angulation. Performance of microsurgical anastomoses was assessed by time, learning curves, and the Anastomosis Lapse Index score for objective performance assessment. RESULTS Refined precision in suturing was achieved with the robot when compared with the manual technique regarding suture distances (p = 0.02) and angulation (p < 0.01). The time required to perform microsurgical anastomoses was longer with the robot, however, both expert and novice microsurgeons reduced times with practice. The objective evaluation of the anastomoses performed by novices showed better results with the robot. CONCLUSIONS This study demonstrated the feasibility of performing precise microsutures and anastomoses using a new robotic system. Compared to standard manual techniques, robotic procedures were longer in time, but showed greater precision.
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Affiliation(s)
- Alberto Ballestín
- Tumor Microenvironment Laboratory, UMR3347 CNRS / U1021 INSERM, Institut Curie, Orsay Paris, France. .,Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
| | - Gerardo Malzone
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Giulio Menichini
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Marco Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
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KIANI AYSHAKARIM, PHEBY DEREK, HENEHAN GARY, BROWN RICHARD, SIEVING PAUL, SYKORA PETER, MARKS ROBERT, FALSINI BENEDETTO, CAPODICASA NATALE, MIERTUS STANISLAV, LORUSSO LORENZO, DONDOSSOLA DANIELE, TARTAGLIA GIANLUCAMARTINO, ERGOREN MAHMUTCERKEZ, DUNDAR MUNIS, MICHELINI SANDRO, MALACARNE DANIELE, BONETTI GABRIELE, DAUTAJ ASTRIT, DONATO KEVIN, MEDORI MARIACHIARA, BECCARI TOMMASO, SAMAJA MICHELE, CONNELLY STEPHENTHADDEUS, MARTIN DONALD, MORRESI ASSUNTA, BACU ARIOLA, HERBST KARENL, KAPUSTIN MYKHAYLO, STUPPIA LIBORIO, LUMER LUDOVICA, FARRONATO GIAMPIETRO, BERTELLI MATTEO. Ethical considerations regarding animal experimentation. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E255-E266. [PMID: 36479489 PMCID: PMC9710398 DOI: 10.15167/2421-4248/jpmh2022.63.2s3.2768] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Animal experimentation is widely used around the world for the identification of the root causes of various diseases in humans and animals and for exploring treatment options. Among the several animal species, rats, mice and purpose-bred birds comprise almost 90% of the animals that are used for research purpose. However, growing awareness of the sentience of animals and their experience of pain and suffering has led to strong opposition to animal research among many scientists and the general public. In addition, the usefulness of extrapolating animal data to humans has been questioned. This has led to Ethical Committees' adoption of the 'four Rs' principles (Reduction, Refinement, Replacement and Responsibility) as a guide when making decisions regarding animal experimentation. Some of the essential considerations for humane animal experimentation are presented in this review along with the requirement for investigator training. Due to the ethical issues surrounding the use of animals in experimentation, their use is declining in those research areas where alternative in vitro or in silico methods are available. However, so far it has not been possible to dispense with experimental animals completely and further research is needed to provide a road map to robust alternatives before their use can be fully discontinued.
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Affiliation(s)
- AYSHA KARIM KIANI
- Allama Iqbal Open University, Islamabad, Pakistan
- MAGI EUREGIO, Bolzano, Italy
| | - DEREK PHEBY
- Society and Health, Buckinghamshire New University, High Wycombe, UK
| | - GARY HENEHAN
- School of Food Science and Environmental Health, Technological University of Dublin, Dublin, Ireland
| | - RICHARD BROWN
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - PAUL SIEVING
- Department of Ophthalmology, Center for Ocular Regenerative Therapy, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - PETER SYKORA
- Department of Philosophy and Applied Philosophy, University of St. Cyril and Methodius, Trnava, Slovakia
| | - ROBERT MARKS
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - BENEDETTO FALSINI
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | | | - STANISLAV MIERTUS
- Department of Biotechnology, University of SS. Cyril and Methodius, Trnava, Slovakia
- International Centre for Applied Research and Sustainable Technology, Bratislava, Slovakia
| | | | - DANIELE DONDOSSOLA
- Center for Preclincal Research and General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - GIANLUCA MARTINO TARTAGLIA
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- UOC Maxillo-Facial Surgery and Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - MAHMUT CERKEZ ERGOREN
- Department of Medical Genetics, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - MUNIS DUNDAR
- Department of Medical Genetics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - SANDRO MICHELINI
- Vascular Diagnostics and Rehabilitation Service, Marino Hospital, ASL Roma 6, Marino, Italy
| | | | | | | | | | | | - TOMMASO BECCARI
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | | | | | - DONALD MARTIN
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, SyNaBi, Grenoble, France
| | - ASSUNTA MORRESI
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - ARIOLA BACU
- Department of Biotechnology, University of Tirana, Tirana, Albania
| | - KAREN L. HERBST
- Total Lipedema Care, Beverly Hills California and Tucson Arizona, USA
| | | | - LIBORIO STUPPIA
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, University "G. d'Annunzio", Chieti, Italy
| | - LUDOVICA LUMER
- Department of Anatomy and Developmental Biology, University College London, London, UK
| | - GIAMPIETRO FARRONATO
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- UOC Maxillo-Facial Surgery and Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - MATTEO BERTELLI
- MAGI EUREGIO, Bolzano, Italy
- MAGI’S LAB, Rovereto (TN), Italy
- MAGISNAT, Peachtree Corners (GA), USA
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García Feijoo P, Carceller F, Isla Guerrero A, Sáez-Alegre M, Gandía González ML. Beyond Classic Anastomoses Training Models: Overview of Aneurysm Creation in Rodent Vessel Model. Front Surg 2022; 9:884675. [PMID: 35521434 PMCID: PMC9062134 DOI: 10.3389/fsurg.2022.884675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Nowadays, due to the decline in the number of microsurgical clippings for cerebral aneurysms and revascularization procedures, young neurosurgeons have fewer opportunities to participate and train on this type of surgery. Vascular neurosurgery is a demanding subspecialty that requires skills that can only be acquired with technical experience. This background pushes the new generations to be ready for such challenging cases by training hard on different available models, such as synthetic tubes, chicken wings, or placenta vessels. Although many training models for vascular neurosurgery have been described worldwide, one of the best is the rodent vessels model. It offers pulsation, coagulation, and real blood flow conditions in a physiologic atmosphere that mimics perfectly the intracranial human vessels environment, especially in terms of size. However, the current differences in governmental different regulations about the use of living animals in medical experimentation and the social awareness, as well as the lack of financial support, cause more difficulties for neurosurgeons to start with that kind of training. In this review, we describe the tools and techniques as basic steps for vascular microsurgery training by using rodent models, that provide an accurate copy of brain vessels environment under stable conditions. The initial three classical known microanastomoses for neurosurgeons are end-to-end, end-to-side, and side-to-side, but in literature, there have been described other more complex exercises for training and investigation, such as aneurysm models. Although there is still little data available, we aim to summarize and discuss aneurysm's training models and reviewed the current literature on the subject and its applications, including a detailed description of the techniques.
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Stogowski P, Fliciński F, Białek J, Dąbrowski F, Piotrowski M, Mazurek T. Microsurgical Anastomosis Rating Scale (MARS10): A Final Product Scoring System for Initial Microsurgical Training. Plast Surg (Oakv) 2021; 29:243-249. [PMID: 34760840 DOI: 10.1177/2292550320969649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background High cost and ethical controversy of using living models in microsurgical training made non-living models more popular. However, non-living models don't provide appropriate feedback of microsurgical performance. Currently existing Global Rating Scales used for advanced microsurgical skills validation are difficult to apply on non-living model. This study presents a simple instrument for basic assessment of microsurgical anastomosis on non-living model. Methods Seventy medical students were divided into 2 groups depending on their prior microsurgical experience. Each participant performed 3 end-to-end anastomoses on chicken femoral artery model. Anastomoses were reviewed by 3 blinded experts and then photographed. Evaluation included a patency tests, longitudinal cut of anastomosis, and the newly proposed tool 10 Point Microsurgical Anastomosis Rating Scale (MARS10). Presented scale consists of 5 factors important for anastomosis closure (anastomosis closure, suture spacing, bites size, knot tying, and cut ends length), graded on 3 point scale (0-2 points). Results were analyzed with analysis of variance, Spearman correlation, and t Student test. Results Anastomoses evaluated by experts as patent significantly correlated with a high summary score in MARS10 scale (r = 0.73 P < .0001). There was a significant difference in MARS10 score between groups (P < .0001). There were no significant inter-rater differences in scoring among all 3 evaluators (p > .05). Conclusions 10 Point Microsurgical Anastomosis Rating Scale is a quick, valid, and reliable tool to assess microsurgical end-to-end arterial anastomoses on non-living model.
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Affiliation(s)
- Piotr Stogowski
- Department of Orthopaedics and Traumatology Medical University of Gdansk, Poland
| | - Filip Fliciński
- Department of Orthopaedics and Traumatology Medical University of Gdansk, Poland
| | - Jan Białek
- Department of Orthopaedics and Traumatology Medical University of Gdansk, Poland
| | - Filip Dąbrowski
- Department of Orthopaedics and Traumatology Medical University of Gdansk, Poland
| | - Maciej Piotrowski
- Department of Orthopaedics and Traumatology Medical University of Gdansk, Poland
| | - Tomasz Mazurek
- Department of Orthopaedics and Traumatology Medical University of Gdansk, Poland
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Oliveira MM, Quittes L, Costa PHV, Ramos TM, Rodrigues ACF, Nicolato A, Malheiros JA, Machado C. Computer vision coaching microsurgical laboratory training: PRIME (Proficiency Index in Microsurgical Education) proof of concept. Neurosurg Rev 2021; 45:1601-1606. [PMID: 34718926 DOI: 10.1007/s10143-021-01663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/17/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
Computer vision (CV) feedback could be aimed as a constant tutor to guide ones proficiency during microsurgical practice in controlled environments. Five neurosurgeons with different levels of microsurgical expertise performed simulated vessel dissection and micro-suture in an ex vivo model for posterior computer analysis of recorded videos. A computer program called PRIME (Proficiency Index of Microsurgical Education) used in this research recognized color-labeled surgical instruments, from downloading videos into a platform, with a range of motion greater than 3 mm, for objective evaluation of number of right and left hand movements. A proficiency index of 0 to 1 was pre-established in order to evaluate continuous training improvement. PRIME computer program captured all hand movements executed by participants, except for small tremors or inconsistencies that have a range of motion inferior to 3 mm. Number of left and right hand movements were graphically expressed in order to guide more objective and efficacious training for each trainee, without requiring body sensors and cameras around the operating table. Participants with previous microsurgical experience showed improvement from 0.2 to 0.6 (p < 0.05), while novices had no improvement. Proficiency index set by CV was suggested, in a self-challenge and self-coaching manner. PRIME would offer the capability of constant laboratory microsurgical practice feedback under CV guidance, opening a new window for oriented training without a tutor or specific apparatus regarding all levels of microsurgical proficiency. Prospective, large data study is needed to confirm this hypothesis.
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Affiliation(s)
- Marcelo Magaldi Oliveira
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil.
| | - Lucas Quittes
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Pollyana Helena Vieira Costa
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Taise Mosso Ramos
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Ana Clara Fidelis Rodrigues
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Arthur Nicolato
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Jose Augusto Malheiros
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Carla Machado
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
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Amygdalos I, Bednarsch J, Meister FA, Erren D, Mantas A, Strnad P, Lang SA, Ulmer TF, Boecker J, Liu W, Jiang D, Bruners P, Neumann UP, Czigany Z. Clinical value and limitations of the preoperative C-reactive-protein-to-albumin ratio in predicting post-operative morbidity and mortality after deceased-donor liver transplantation: a retrospective single-centre study. Transpl Int 2021; 34:1468-1480. [PMID: 34157178 DOI: 10.1111/tri.13957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 12/17/2022]
Abstract
Liver transplantation is still associated with a high risk of severe complications and post-operative mortality. This study examines the predictive value of the preoperative C-reactive-protein-to-albumin ratio (CAR) regarding perioperative morbidity and mortality in deceased-donor liver transplantation (DDLT) recipients. In total, 390 DDLT recipients between 05/2010 and 03/2020 were eligible. Predictive abilities of CAR were examined through receiver operating characteristic curve (ROC) analyses. Groups were compared using parametric and non-parametric tests as appropriate. Independent risk factors for morbidity and mortality were identified using uni- and multivariable logistic regression analyses. A good predictive ability for CAR was shown regarding perioperative morbidity (comprehensive complication index ≥75, Clavien-Dindo score ≥4a) and 12-month mortality, with an ideal cut-off of CAR = 26%. Patients with CAR>26% had significantly higher median CCI scores (60 vs. 43, P < 0.001), longer intensive care unit (ICU, 5 vs. 4 days, P < 0.001) and hospital (28 vs. 21 days, P < 0.001) stays and higher 12-month mortality rates (20% vs 6%, P < 0.001). Multivariable analyses identified CAR>26%, pre-OLT inpatient hospitalization (including ICU) and post-operative red blood cell transfusions as independent predictors of severe cumulative morbidity (CCI≥75). Preoperative CAR might be a reliable additional tool to predict perioperative morbidity and mortality in DDLT recipients.
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Affiliation(s)
- Iakovos Amygdalos
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | | | - David Erren
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Anna Mantas
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Pavel Strnad
- Department of Internal Medicine III, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Sven Arke Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Joerg Boecker
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Wenjia Liu
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Decan Jiang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Bruners
- Institute of Radiology, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
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Meister FA, Bednarsch J, Amygdalos I, Boecker J, Strnad P, Bruners P, Lang SA, Ulmer TF, Heij L, Santana DAM, Liu WJ, Lurje G, Neumann UP, Czigany Z. Various myosteatosis selection criteria and their value in the assessment of short- and long-term outcomes following liver transplantation. Sci Rep 2021; 11:13368. [PMID: 34183733 PMCID: PMC8239038 DOI: 10.1038/s41598-021-92798-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
Body composition and myosteatosis affect clinical outcomes in orthotopic liver transplantation (OLT). Here we aimed to compare the value and limitations of various selection criteria to define pre-transplant myosteatosis in the assessment of short- and long-term outcomes following OLT. We retrospectively analyzed the data of 264 consecutive recipients who underwent deceased donor OLT at a German university medical centre. Myosteatosis was evaluated by preoperative computed-tomography-based segmentation. Patients were stratified using muscle radiation attenuation of the whole muscle area (L3Muslce-RA), psoas RA (L3Psoas-RA) and intramuscular adipose tissue content (IMAC) values. L3Muslce-RA, L3Psoas-RA and IMAC performed well without major differences and identified patients at risk for inferior outcomes in the group analysis. Quartile-based analyses, receiver operating characteristic curve and correlation analyses showed a superior association of L3Muslce-RA with perioperative outcomes when compared to L3Psoas-RA and L3IMAC. Long-term outcome did not show any major differences between the used selection criteria. This study confirms the prognostic role of myosteatosis in OLT with a particularly strong value in the perioperative phase. Although, based on our data, L3Muscle-RA might be the most suitable and recommended selection criterion to assess CT-based myosteatosis when compared to L3Psoas-RA and L3IMAC, further studies are warranted to validate these findings.
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Affiliation(s)
- Franziska Alexandra Meister
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Iakovos Amygdalos
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Joerg Boecker
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Pavel Strnad
- Department of Internal Medicine III, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Bruners
- Institute of Radiology, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Sven Arke Lang
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Tom Florian Ulmer
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Lara Heij
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Institute for Pathology, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniel Antonio Morales Santana
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Wen-Jia Liu
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Georg Lurje
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Zoltan Czigany
- Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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17
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Giuliani M, Martimianakis MA(T, Broadhurst M, Papadakos J, Fazelzad R, Driessen EW, Frambach J. Motivations for and Challenges in the Development of Global Medical Curricula: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:449-459. [PMID: 32271225 PMCID: PMC7899747 DOI: 10.1097/acm.0000000000003383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The aim of this scoping review is to understand the motivations for the creation of global medical curricula, summarize methods that have been used to create these curricula, and understand the perceived premises for the creation of these curricula. METHOD In 2018, the authors used a comprehensive search strategy to identify papers on existing efforts to create global medical curricula published from 1998 to March 29, 2018, in the following databases: MEDLINE; MEDLINE Epub Ahead of Print, In-Process, and Other Non-Indexed Citations; Embase; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; PsycINFO; CINAHL; ERIC; Scopus; African Index Medicus; and LILACS. There were no language restrictions. Two independent researchers applied the inclusion and exclusion criteria. Demographic data were abstracted from publications and summarized. The stated purposes, methods used for the development, stated motivations, and reported challenges of curricula were coded. RESULTS Of the 18,684 publications initially identified, 137 met inclusion criteria. The most common stated purposes for creating curricula were to define speciality-specific standards (50, 30%), to harmonize training standards (38, 23%), and to improve the quality or safety of training (31, 19%). The most common challenges were intercountry variation (including differences in health care systems, the operationalization of medical training, and sociocultural differences; 27, 20%), curricular implementation (20, 15%), and the need for a multistakeholder approach (6, 4%). Most curricula were developed by a social group (e.g., committee; 30, 45%) or Delphi or modified Delphi process (22, 33%). CONCLUSIONS The challenges of intercountry variation, the need for a multistakeholder approach, and curricular implementation need to be considered if concerns about curricular relevance are to be addressed. These challenges undoubtedly impact the uptake of global medical curricula and can only be addressed by explicit efforts to make curricula applicable to the realities of diverse health care settings.
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Affiliation(s)
- Meredith Giuliani
- M. Giuliani is staff radiation oncologist and medical director, Cancer Education Program, Princess Margaret Cancer Centre, and associate professor, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-1827-5590
| | - Maria Athina (Tina) Martimianakis
- M.A. Martimianakis is associate professor and director of medical education scholarship, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2531-3156
| | - Michaela Broadhurst
- M. Broadhurst is research analyst, Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janet Papadakos
- J. Papadakos is codirector, Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, and assistant professor, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6320-4156
| | - Rouhi Fazelzad
- R. Fazelzad is information specialist, Library and Information Services, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Erik W. Driessen
- E.W. Driessen is professor and chair, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-8115-261X
| | - Janneke Frambach
- J. Frambach is assistant professor, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-1527-6539
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Oltean M, Nistor A, Hellström M, Axelsson M, Yagi S, Kobayashi E, Ballestin A, Akelina Y, Nemeth N. Microsurgery training during COVID-19 pandemic: Practical recommendations from the International Society for Experimental Microsurgery and International Microsurgery Simulation Society. Microsurgery 2021; 41:398-400. [PMID: 33606305 PMCID: PMC8014550 DOI: 10.1002/micr.30725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mihai Oltean
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,The Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Scandinavian Microsurgery Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandru Nistor
- Division of Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.,Pius Branzeu Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Mats Hellström
- The Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Scandinavian Microsurgery Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Axelsson
- Scandinavian Microsurgery Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Eiji Kobayashi
- Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan
| | - Alberto Ballestin
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Yelena Akelina
- Microsurgery Research and Training Laboratory, Columbia University, New York, New York, USA
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Gasteratos K, Paladino JR, Akelina Y, Mayer HF. Superiority of living animal models in microsurgical training: beyond technical expertise. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:167-176. [PMID: 33589852 PMCID: PMC7875764 DOI: 10.1007/s00238-021-01798-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
Background Many studies are investigating the role of living and nonliving models to train microsurgeons. There is controversy around which modalities account for the best microsurgical training. In this study, we aim to provide a systematic literature review of the practical modalities in microsurgery training and compare the living and nonliving models, emphasizing the superiority of the former. We introduce the concept of non-technical skill acquisition in microsurgical training with the use of living laboratory animals in the context of a novel proposed curriculum. Methods A literature search was conducted on PubMed/Medline and Scopus within the past 11 years based on a combination of the following keywords: “microsurgery,” “training,” “skills,” and “models.” The online screening process was performed by two independent reviewers with the Covidence tool. A total of 101 papers was identified as relevant to our study. The protocol was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Living models offer the chance to develop both technical and non-technical competencies (i.e., leadership, situation awareness, decision-making, communication, and teamwork). Prior experience with ex vivo tissues helps residents consolidate basic skills prior to performing more advanced techniques in the living tissues. Trainees reported a higher satisfaction rate with the living models. Conclusions The combination of living and nonliving training microsurgical models leads to superior results; however, the gold standard remains the living model. The validity of the hypothesis that living models enhance non-technical skills remains to be confirmed. Level of evidence: Not ratable.
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Affiliation(s)
- Konstantinos Gasteratos
- Department of Plastic and Reconstructive Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Yelena Akelina
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY USA
| | - Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
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Mattar TGDM, dos Santos GB, Telles JPM, de Rezende MR, Wei TH, Mattar R. Structured evaluation of a comprehensive microsurgical training program. Clinics (Sao Paulo) 2021; 76:e3194. [PMID: 34669876 PMCID: PMC8491592 DOI: 10.6061/clinics/2021/e3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study proposed a structured microsurgical training program and evaluated it with the assistance of a large sample of surgeons. METHODS The practical course comprised 16 sessions of approximately 4 hours each. This included two sessions for suturing rubber gloves and two sessions for suturing arteries, veins, and nerves in chicken thighs. The other sessions were performed on the femoral vessels of rats: 5 sessions for end-to-end arterial anastomosis, 5 for end-to-end venous anastomosis, 1 for arterial grafting, and 1 for end-to-side anastomosis. We conducted a structured assessment of the microsurgical skills in each training session. RESULTS In this study, 89 surgeons were evaluated. The mean scores for the different procedures were as follows: glove suturing, 33.3±0.59; chicken nerve end-to-end anastomosis, 40.3±0.49; chicken artery suturing, 40.9±0.36; chicken vein suturing, 42.3±0.36; graft interposition, 44.8±0.7; and end-to-side anastomosis, 43.7±0.63 (p<0.05 for all). The chicken thigh suturing scores were significantly higher than the rubber gloves suturing scores (p<0.01). There were no differences between scores of the rat artery and chicken thigh suturing procedures (p=0.24). The rat venous anastomosis scores were higher than the rat arterial anastomosis scores (p=0.02), as were graft interposition scores when compared with end-to-end venous anastomosis scores. The end-to-side anastomosis scores did not differ significantly from the grafting scores (p=0.85). The most common errors were inadequate knotting technique and suture rupture due to inadequate technique (both n=88 [98.9%]). CONCLUSION We propose a 16-step, progressive microsurgical training program to learn the basic microsurgical techniques comprehensively and reliably. The program was evaluated in a large sample of trainees, and it demonstrated the adequacy of the training sequence and results.
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Affiliation(s)
- Tiago Guedes da Motta Mattar
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Gustavo Bispo dos Santos
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | | | - Marcelo Rosa de Rezende
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Teng Hsiang Wei
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Rames Mattar
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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Sugai K, Hakamata Y, Tamura T, Kataoka M, Fujisawa M, Sano M, Kobayashi E. A microsurgical technique for catheter insertion in the rat femoral artery. Acta Cir Bras 2020; 35:e202001004. [PMID: 33237176 PMCID: PMC7709899 DOI: 10.1590/s0102-865020200100000004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose: To modify a surgical catheterization method using the bent needle introducer in small animals. Methods: Eight-week-old male Lewis rats were used in the study. A needle introducer was created by bending a 21G injection needle at 45°. The bent needle introducer was used for catheter insertion into the left femoral artery of the rats under anesthesia. As a control, a catheter was directly inserted into the blood vessel without the introducer. The insertion time of each method was measured. Blood pressure and heart rate were measured 24 h after catheter insertion using the telemetry system. Results: Using the introducer, the catheter was successfully inserted within a short time in all rats. Without the introducer, a longer duration was required for catheter insertion. The frequency of the insertion with no catheter-based errors with the introducer tended to be higher than that without the introducer. The mean arterial pressure and heart rate 24 h after catheter insertion in each group were almost the same. Conclusions: We developed a surgical catheterization method using the introducer in small animals. This could potentially reduce the frequency of the insertion with catheter-based errors and insertion time.
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Affiliation(s)
| | - Yoji Hakamata
- Nippon Veterinary and Life Science University, Japan
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22
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Kobayashi E, Yamashita S. A training tool for lymphatic vessel anastomosis in supermicrosurgery: An ultrafine polyvinyl alcohol tube. Microsurgery 2020; 40:930-931. [PMID: 32644265 DOI: 10.1002/micr.30625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/27/2020] [Accepted: 06/19/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Eiji Kobayashi
- Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Yamashita
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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23
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Wang Z, Wang H, Kong F, Chen Z, Wu H, Wang X, Jian F. Application of a Microsurgical Space Restrictor in Microsurgical Simulation Training. World Neurosurg 2020; 140:e289-e293. [PMID: 32407919 DOI: 10.1016/j.wneu.2020.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the effect of the application of a microsurgical space restrictor in microsurgical simulation training. METHODS A microsurgical space restrictor that can restrict the operation space was designed and produced. Forty neurosurgery residents with standardized training were selected as the study subjects and were randomly divided into the experimental group (group A) and the control group (group B). Group A was trained using the space restrictor, and group B was trained using the traditional method. The skills and overall performance of the 2 groups of trainees were assessed by the Stanford Microsurgery and Resident Training (SMaRT) scale. The assessment was divided into 2 stages: the unobstructed microsurgery test, and the test with the microsurgical operation space restrictor. RESULTS In group A, the score for the first stage (A1) was 3.9 ± 0.6, the score for the second stage (A2) was 3.4 ± 0.6, and the score for A1 was better than that for A2 (P = 0.000); in group B, the score for the first stage (B1) was 3.57 ± 0.6, the score for the second stage (B2) was 3.0 ± 0.6, and the score for B1 was better than that for B2 (P = 0.000). Overall, the score for A1 was better than that for B1 (P = 0.046), and the score for A2 was better than that for B2 (P = 0.009). CONCLUSIONS Microsurgical space restrictor use can improve the effect of microsurgical simulation training and help trainees better master microsurgical operation skills.
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Affiliation(s)
- Zuowei Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Neurospine Center, China International Neuroscience Institute, Beijing, People's Republic of China; Department of Neurosurgery, Education Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Haifeng Wang
- Department of Neurosurgery, Education Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Feng Kong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Neurospine Center, China International Neuroscience Institute, Beijing, People's Republic of China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Neurospine Center, China International Neuroscience Institute, Beijing, People's Republic of China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Neurospine Center, China International Neuroscience Institute, Beijing, People's Republic of China
| | - Xingwen Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Neurospine Center, China International Neuroscience Institute, Beijing, People's Republic of China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Neurospine Center, China International Neuroscience Institute, Beijing, People's Republic of China.
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24
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Rajan S, Sathyan R, Sreelesh LS, Kallerey AA, Antharjanam A, Sumitha R, Sundar J, John RJ, Soumya S. Objective Assessment of Microsurgery Competency-In Search of a Validated Tool. Indian J Plast Surg 2019; 52:216-221. [PMID: 31602138 PMCID: PMC6785309 DOI: 10.1055/s-0039-1695658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Microsurgical skill acquisition is an integral component of training in plastic surgery. Current microsurgical training is based on the subjective Halstedian model. An ideal microsurgery assessment tool should be able to deconstruct all the subskills of microsurgery and assess them objectively and reliably. For our study, to analyze the feasibility, reliability, and validity of microsurgery skill assessment, a video-based objective structured assessment of technical skill tool was chosen. Two blinded experts evaluated 40 videos of six residents performing microsurgical anastomosis for arteriovenous fistula surgery. The generic Reznick's global rating score (GRS) and University of Western Ontario microsurgical skills acquisition/assessment (UWOMSA) instrument were used as checklists. Correlation coefficients of 0.75 to 0.80 (UWOMSA) and 0.71 to 0.77 (GRS) for interrater and intrarater reliability showed that the assessment tools were reliable. Convergent validity of the UWOMSA tool with the prevalidated GRS tool showed good agreement. The mean improvement of scores with years of residency was measured with analysis of variance. Both UWOMSA (
p
-value: 0.034) and GRS (
p
-value: 0.037) demonstrated significant improvement in scores from postgraduate year 1 (PGY1) to PGY2 and a less marked improvement from PGY2 to PGY3. We conclude that objective assessment of microsurgical skills in an actual clinical setting is feasible. Tools like UWOMSA are valid and reliable for microsurgery assessment and provide feedback to chart progression of learning. Acceptance and validation of such objective assessments will help to improve training and bring uniformity to microsurgery education.
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Affiliation(s)
- Sheeja Rajan
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India.,MCI Regional Centre for Medical Education Technology, Kozhikode, Kerala, India
| | - Ranjith Sathyan
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India
| | - L S Sreelesh
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India
| | | | | | - Raj Sumitha
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India
| | - Jinchu Sundar
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India
| | - Ronnie Johnson John
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India
| | - S Soumya
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India
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25
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Javid P, Aydın A, Mohanna P, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: A systematic review. Microsurgery 2019; 39:655-668. [DOI: 10.1002/micr.30513] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/25/2019] [Accepted: 08/30/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Pernia Javid
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Abdullatif Aydın
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Pari‐Naz Mohanna
- Department of Plastic SurgeryGuy's and St. Thomas' NHS Foundation Trust London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
- Department of UrologyKing's College Hospital NHS Foundation Trust London UK
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Nemeth N, Miko I, Furka I. Experiences with basic microsurgical training programs and skill assessment methods at the University of Debrecen, Hungary. Acta Cir Bras 2018; 33:842-852. [PMID: 30328917 DOI: 10.1590/s0102-865020180090000013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/04/2018] [Indexed: 11/22/2022] Open
Abstract
During the past decades microsurgical training programs together with skill assessment methods had been developing intensively worldwide. Concerning the teaching of basic techniques at various levels, we aimed to summarize the education program types and experiences at our department, in order to define the way of continuity. All in the hope that this summary might contain useful information for other educators as well. About 50 years ago, in the late 1960s, microsurgical basic education had been established in Debrecen. Since the 1990s multilevel education programs have been developed, starting in undergraduate years up to the postgraduate training, residency and continuous medical education programs. In the last three decades about 2,300 participants completed courses, including over 470 residents. The ones who already succeeded microsurgical course as medical students, during residency program could reach better results and skill development. Concluding thoughts, the traditional methods and special experiences are highly important in microsurgical education. The necessary duration and individual training approach are emphasized. Standardization (self and international), comparability, accessibility, providing milestones of microsurgical skills are key factors. Proper feedback and skill assessment (experiences, internationally recognized scores, or combinations) are indispensable, but have to be fitted to the characteristic elements of the course.
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Affiliation(s)
- Norbert Nemeth
- PhD, DSc, Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Hungary. Conception and design of the study, manuscript preparation and writing, final approval
| | - Iren Miko
- PhD, Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Hungary. Conception and design of the study, manuscript preparation and writing, final approval
| | - Istvan Furka
- PhD, DSc, Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Hungary. Conception and design of the study, manuscript preparation and writing, final approval
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