Learning Curve for Rat Intestinal Transplantation: Milestones From a Single Surgeon's Perspective.

Area of Science:

• Surgical innovation
• Microsurgery techniques
• Transplantation research

Background:

• The rat intestinal transplant (ITx) model presents a steep learning curve (LC) due to complex microsurgical demands.
• Lack of clear milestones hinders widespread adoption of the rat ITx model despite defined benchmarks.
• This study introduces a methodology to assess LC progression and skill acquisition in rat ITx.

Purpose of the Study:

• To present a structured methodology for evaluating learning curve progression in the rat intestinal transplant model.
• To define clear, stepwise milestones for mastering the rat ITx procedure.
• To establish objective criteria for assessing proficiency in rat ITx.

Main Methods:

• A single surgeon's experience developing the rat ITx model without prior microsurgical training was documented.
• The learning curve was divided into three milestones: microsurgical skills, graft procurement, and graft implantation.
• Surgical times and survival rates were used to assess LC progression, with cumulative sum chart analysis applied to anastomosis time.

Main Results:

• Initial microsurgical practice involved chicken thighs and rat cadavers, followed by procedures on live rats.
• Cumulative sum chart analysis indicated 34 rat intestinal transplant procedures were necessary to achieve anastomosis time targets (R² = 0.95).
• Achieving anastomosis time targets was directly correlated with an improved 7-day survival rate.

Conclusions:

• The proposed methodology, utilizing stepwise milestones, facilitated the successful development of the rat intestinal transplant model.
• Mastery of the rat ITx learning curve, encompassing all three milestones, required 34 procedures.
• This structured approach aids in standardizing training and improving outcomes for the rat ITx model.