A Novel Supermicrosurgery Training Model: Exercise for Lymphovenular Anastomosis

Proficiency in supermicrosurgery is essential for successful lymphovenular anastomosis (LVA) procedures. Existing training models often lack realistic simulation of lymphatic vessels or dynamic postoperative observation. This study aimed to develop a novel, reproducible, and user-friendly animal model for supermicrosurgical training. Adult male Sprague-Dawley rats (300 g) were anesthetized, and their tails were immobilized. A lateral incision exposed the caudal lateral veins and lymphatic vessels, which were visualized using methylene blue staining. Under microscopic guidance, end-to-end and end-to-side LVAs were performed on the caudal lymphatic vessels (average diameter: 0.3 mm) and veins (diameter: 0.3-0.8 mm). Anastomotic patency was assessed postoperatively. The model enabled dynamic observation of anastomoses, with patency confirmed by melphalan staining and manual perfusion tests. Trainees completed at least 20 anastomoses per session, demonstrating proficiency in both anastomosis techniques. The thin-walled lymphatic vessels closely resembled those in clinical lymphedema cases, providing realistic training conditions. The model also allowed for repeated practice and postoperative evaluation of histological and fluid dynamic changes. The rat caudal LVA model is a highly reproducible and practical tool for supermicrosurgical training. It addresses limitations of existing models by combining simplicity, cost-effectiveness, and clinical relevance. This model is ideal for advancing LVA skills and preparing surgeons for real-world scenarios.