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Published on: October 26, 2019
A New Synthetic Model for Microvascular Anastomosis Training? A Randomized Comparative Study Between Silicone and
Michael Atlan1, Alexandre G Lellouch2, Josette Legagneux3
1Faculty of Medicine, University Pierre et Marie Curie, Paris, France; Plastic Surgery Department, APHP, Hôpital Tenon, Paris, France; Department of Microsurgery, Faculty of Medicine, School of Surgery of Paris, University Pierre et Marie Curie, Paris, France; Inserm; Institut National de la Sante et de la Recherche Medicale 1148, Laboratory for Vascular Translational Science, University Paris Diderot, University Paris 13, CHU X Bichat, Paris, France.
Introduction:
Assessment of a resident's microsurgical competency with the rodent model remains the current gold standard. However, cost and ethical issues related to animal welfare may limit training opportunities. Therefore, synthetic alternatives such as silicone tubes have been developed to provide easy access to training, shorten the learning curve, and have been incorporated into microsurgical courses as a low-fidelity model for basic skills acquisition. This study compares the use of polyvinyl alcohol (PVA) gelatin tubes with silicone for resident microsurgical training.
Material And Methods:
Residents were randomized into silicone (S) or PVA (P) groups and underwent the same training. Following basic instruction, microsurgical anastomoses were performed with the rat's aorta or carotid artery or both. Performance was assessed using the Objective Structured Assessment of Technical Skills (OSATS) score and 5 different items to assess the quality of the anastomosis. Posttest questionnaires were also conducted for qualitative assessment of both students' and trainers' experience with silicone and PVA in comparison with rat vessels.
Results:
OSATS score in Group P was higher than Group S (18.2 ± 2.6 vs 16.6 ± 2.5, p = 0.015). Results of anastomoses were similarly better in Group P based on OSATS score (19.3 ± 1.2 vs 17.7 ± 0.7, p = 0.027). Subjectively, both students and trainers found that PVA tubes resembled the rat aorta more closely than silicone. The number of rats used was also significantly lower in Group P than Group S (65 vs 75 total, p = 0.023).
Conclusion:
PVA gelatin tubes may be a viable alternative to silicone for microsurgical training because this synthetic model mirrors better rat vessels and can improve training performance based on objective assessment while using less animals overall.
