Supermicrosurgical Anastomosis Training Using Chick Embryos within the Egg-in-Cube System

Area of Science:

• Surgical Education
• Biomedical Engineering
• Developmental Biology

Background:

• Supermicrosurgery, crucial for lymphatic and perforator-flap surgery, lacks an ideal training model.
• Current living animal models are expensive and raise ethical concerns.
• A need exists for a cost-effective, reproducible, and ethically sound training system.

Purpose of the Study:

• To develop and evaluate a novel supermicrosurgical anastomosis training system using chicken embryos.
• To provide a cost-effective and ethically acceptable alternative to traditional animal models.
• To assess the suitability of the chicken embryo model for supermicrosurgical skill acquisition.

Main Methods:

• A novel "egg-in-cube" system was created using artificial eggshells with polycarbonate frames and polydimethylsiloxane membranes.
• Fertilized chicken embryos were cultured within this system.
• Trainees performed supermicrosurgical anastomosis on the vitelline artery (average diameter 0.43 mm) of 7-day-old chick embryos.

Main Results:

• The system successfully supported supermicrosurgical training in 11 surviving chicken embryos.
• Vessel patency and pulsation post-anastomosis were observed in 4 out of 11 cases.
• The vitelline artery diameter closely mimics that of human lymphatic vessels.

Conclusions:

• The chicken embryo within the egg-in-cube system is an ethically acceptable, cost-effective, and manageable supermicrosurgical training model.
• Its anatomical similarity to human lymphatic vessels makes it suitable for practicing lymphovenular anastomosis.
• The model provides real-time feedback on anastomosis patency and leakage due to its integrated circulation.