title: Microsurgical Training with the Three-Step Approach.
abstract: BackgroundMicrosurgery is very challenging, requiring a high degree of dexterity and manual skills that should be fully trained outside of the operating room. Common microsurgery courses usually follow a stepwise training approach beginning practice on nonliving models and proceeding with live rats. However, training on live rats raises certain issues, including ethical concerns as well as the associated costs. As such, there is an increasing drive toward alternative models. The current article describes a three-step training approach (latex glove-endovascular prosthesis-human placenta), which aims to prepare trainees for the clinical direct application. Also, to validate it, this approach was compared with microsurgical training on rats.MethodsOverall, 20 residents were randomly assigned to two different microsurgical training courses, each based on one of the aforementioned approaches. Residents were evaluated in terms of correct handling of the instruments, correct use of the microscope, adventectomy, triangulation technique, posterior wall technique, success of the end-to-end anastomosis, and ability in assisting the tutor during the arterial anastomosis.ResultsThe three-step and the live rats groups evidenced similar scores in term of acquired basic skill levels.ConclusionsThe three-step model allows to progressively gain skills on microsurgical techniques and to perform a good vascular anastomosis without the need of further steps on rats. The availability of both endovascular prosthesis and human placenta makes this training model definitely accessible from a practical and logistical point of view.
authors.affiliation: Department of Surgery, Microsurgery and Plastic Surgery, University of Sassari, Sassari, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Trignano
authors.affiliation: Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Nefer
authors.initials: N
authors.lastname: Fallico
authors.affiliation: Department of Surgery, Microsurgery and Plastic Surgery, University of Sassari, Sassari, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Zingone
authors.affiliation: Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Luca Andrea
authors.initials: LA
authors.lastname: Dessy
authors.affiliation: Department of Surgery, Microsurgery and Plastic Surgery, University of Sassari, Sassari, Italy.
authors.forename: Gian Vittorio
authors.initials: GV
authors.lastname: Campus
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education*; D032761:Animal Experimentation / Q000941:ethics*; D000818:Animals; D001158:Arteries / Q000473:pathology* / Q000601:surgery; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007558:Italy; D008866:Microsurgery / Q000193:education*; D023421:Models, Animal; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011446:Prospective Studies; D011897:Random Allocation; D051381:Rats; D014656:Vascular Surgical Procedures / Q000193:education*