title: Training of A3-A3 side-to-side anastomosis in a deep corridor using a box with 6.5-cm depth: technical note.
abstract: BACKGROUND
  Cerebral revascularization in the deep surgical field is technically challenging. Especially, side-to-side anastomosis like A3-A3 could be technically more difficult compared with end-to-side anastomosis. To improve surgeon's dexterity and maneuverability in the deep surgical field, the authors developed an easily accessible and well-simulating training system using prosthetic tubes and a box.
  
  
  METHODS
  Two prosthetic tubes (silicon tube, 1.2 mm in diameter) are mounted in parallel on the bottom of 6.5-cm-deep emptied 'tissue paper box.' The orifice of the box is restricted to 2 x 2 cm to simulate a deep and narrow surgical corridor. Using bayonet-shaped micro needle holder and forceps, the side-to-side anastomosis of the tubes is performed with 10-0 nylon under operative microscope.
  
  
  RESULTS
  Prosthetic tubes well simulated real A3-A3 anastomosis. From the standpoint of technical difficulty, this training system needed slightly higher level of dexterity compared with real A3-A3 anastomosis because of narrower and deeper surgical corridor, and the wall of prosthetic tube was slightly thicker and more inflexible. After this training, the surgical technique in real A3-A3 anastomosis was improved.
  
  
  CONCLUSIONS
  This training system worked well to ease the transition from anastomosis in shallow surgical field to deep and narrow surgical field. The prosthetic tube we used approximates real A3 relatively well, and the ease in setting up this system enabled repeated practice, which resulted in steep learning curve of the technique.
authors.affiliation: Department of Neurosurgery, Showa General Hospital, Tokyo 187-8510, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Inoue
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Saito
authors.forename: Shinobu
authors.initials: S
authors.lastname: Adachi
authors.forename: Shota
authors.initials: S
authors.lastname: Tanaka
authors.forename: Naoto
authors.initials: N
authors.lastname: Kunii
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D009493:Neurosurgery / Q000193:education*; D013536:Suture Techniques; D013663:Teaching / Q000379:methods*