scholarly journals Learning Curve for Microvascular Anastomosis with the Silicone Tube Training Model: An Attempt to Set Training Goals for Young Neurosurgeons

2016 ◽  
Vol 44 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Bumpei KIKUCHI ◽  
Kenichi KAKINUMA ◽  
Keisuke SATO ◽  
Hideaki WATANABE
Keyword(s):  
Learning Curve ◽  
Training Model ◽  
Microvascular Anastomosis ◽  
Silicone Tube

scholarly journals Training model for the intraluminal continuous suturing technique for microvascular anastomosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zongyu Xiao ◽  
Madjid Samii ◽  
Ji Wang ◽  
Qi Pan ◽  
Zhimin Xu ◽  
...  
Keyword(s):  
Abdominal Aorta ◽  
Posterior Wall ◽  
Training Model ◽  
Microvascular Anastomosis ◽  
Silicone Tube ◽  
Iliac Arteries ◽  
Suturing Technique ◽  
End To End ◽  
Suturing Techniques ◽  
Common Iliac Arteries

AbstractMicrovascular anastomosis is a critical procedure in cerebral bypass surgeries. In some rare cases, the extraluminal interrupted technique is not optimal because the vessels are immobile and cannot be rotated, and anastomosis can be performed effectively through the intraluminal continuous suturing technique. The authors reported the application of the intraluminal continuous suturing technique in microanastomosis training with silicone tube, rat’s common iliac arteries and abdominal aorta. A silicone tube with a diameter of 1.5 mm was used to practice microanastomosis in intraluminal continuous suturing technique. Then the technique was applied in side-to-side, end-to-side anastomoses of common iliac arteries and the end-to-end abdominal aorta anastomoses of rat. The suturing time and patency rates were compared with an alternative intraluminal continuous suturing technique and one-way-up interrupted suturing technique in silicone tube and rat vessel anastomoses. The intraluminal continuous suturing technique could be gained through practicing with silicone tube, and the technique has also been demonstrated effective in side-to-side, end-to-side anastomoses of common iliac arteries of rat and the abdominal aorta end-to-end anastomoses. In all the animal experimental groups with different suturing techniques, there was no difference between the patency rates, all the immediate patency rate was 100%. There was no significant suturing time difference between the two intraluminal continuous suturing techniques, but the two intraluminal continuous suturing techniques were faster than the interrupted technique. The intraluminal continuous suturing technique described in the study could be used as an efficient method for side-to-side, end-to-side and end-to-end anastomosis, especially under the situation the posterior wall of the anastomosis could not be rotated. Proficiency of the technique could be achieved through practicing in laboratory with silicone tube and live animals.

Hand-Assisted Laparoscopic Donor Nephrectomy: Analysis of the Learning Curve in a Training Model In Vivo

2009 ◽  
Vol 41 (4) ◽  
pp. 1125-1127 ◽  
Author(s):  
G. Cavallari ◽  
M. Tsivian ◽  
F. Neri ◽  
R. Bertelli ◽  
A. Faenza ◽  
...  
Keyword(s):  
Learning Curve ◽  
Training Model ◽  
Donor Nephrectomy ◽  
Laparoscopic Donor Nephrectomy

scholarly journals Rapid learning curve assessment in an ex vivo training system for microincisional glaucoma surgery

2017 ◽  
Author(s):  
Yalong Dang ◽  
Susannah Waxman ◽  
Chao Wang ◽  
Hardik A Parikh ◽  
Igor I Bussel ◽  
...  
Keyword(s):  
Learning Curve ◽  
Ex Vivo ◽  
Glaucoma Surgery ◽  
Training Model ◽  
Training System ◽  
Half Maximum ◽  
Confined Space ◽  
Ex Vivo Model ◽  
Mixed Effect ◽  
Ab Interno

Purpose: Microincisional glaucoma surgeons operate in a highly confined space, making it difficult to learn by observation or assistance alone. We hypothesized that an ex vivo model would allow for better refinement of technique, quantification of progress, and computation of a learning curve. Methods: Seven trainees without angle surgery experience performed nine ab interno trabeculectomies in pig eyes (n=63) after preparing with training slides and videos. Trainees placed the eyes on a tiltable mannequin head, visualized the trabecular meshwork gonioscopically through an ophthalmic microscope, and removed it by trabectome-mediated ablation. An expert surgeon observed, guided, and rated the procedure using an Operating Room Score (ORS). The extent of accessed outflow beds was estimated with canalograms using fluorescent microspheres. Data was fit using mixed effect models. Results: ORS reached a half-maximum on an asymptote after only 2.5 eyes. Surgical time decreased by 0.9 minutes per eye in linear fashion. The ablation arc followed an asymptotic function with a half-maximum inflection point after 5.3 eyes. The mean ablation arc improved from 73 to 135 degrees. Canalograms revealed that this progress did not correlate well with improvement in outflow instead suggesting that about 30 eyes are needed for true mastery. Conclusion: This inexpensive pig eye model provides a safe and effective training model for ab interno trabeculectomy and allows for quantification of outcomes. Trainees without prior angle surgery experience improved quickly. Actual outflow improvements progressed at a slower rate, which serves as a reminder to remain humbly committed to training.

scholarly journals The Exoscope versus operating microscope in microvascular surgery: A simulation non-inferiority trial

2020 ◽  
Vol 47 (3) ◽  
pp. 242-249
Author(s):  
Georgios Pafitanis ◽  
Michalis Hadjiandreou ◽  
Alexander Alamri ◽  
Christopher Uff ◽  
Daniel Walsh ◽  
...  
Keyword(s):  
Learning Curve ◽  
Statistical Significance ◽  
Digital Camera ◽  
Suture Line ◽  
Absolute Difference ◽  
Operating Microscope ◽  
Microvascular Anastomosis ◽  
High Definition ◽  
Camera System ◽  
Significant Difference

Background The Exoscope is a novel high-definition digital camera system. There is limited evidence signifying the use of exoscopic devices in microsurgery. This trial objectively assesses the effects of the use of the Exoscope as an alternative to the standard operating microscope (OM) on the performance of experts in a simulated microvascular anastomosis.Methods Modus V Exoscope and OM were used by expert microsurgeons to perform standardized tasks. Hand-motion analyzer measured the total pathlength (TP), total movements (TM), total time (TT), and quality of end-product anastomosis. A clinical margin of TT was performed to prove non-inferiority. An expert performed consecutive microvascular anastomoses to provide the exoscopic learning curve until reached plateau in TT.Results Ten micro sutures and 10 anastomoses were performed. Analysis demonstrated statistically significant differences in performing micro sutures for TP, TM, and TT. There was statistical significance in TM and TT, however, marginal non-significant difference in TP regarding microvascular anastomoses performance. The intimal suture line analysis demonstrated no statistically significant differences. Non-inferiority results based on clinical inferiority margin (Δ) of TT=10 minutes demonstrated an absolute difference of 0.07 minutes between OM and Exoscope cohorts. A 51%, 58%, and 46% improvement or reduction was achieved in TT, TM, TP, respectively, during the exoscopic microvascular anastomosis learning curve.Conclusions This study demonstrated that experts’ Exoscope anastomoses appear non-inferior to the OM anastomoses. Exoscopic microvascular anastomosis was more time consuming but end-product (patency) in not clinically inferior. Experts’ “warm-up” learning curve is steep but swift and may prove to reach clinical equality.

scholarly journals The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 489-496 ◽  
Author(s):  
Alessia Ferrarese ◽  
Valentina Gentile ◽  
Marco Bindi ◽  
Matteo Rivelli ◽  
Jacopo Cumbo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Learning Curve ◽  
General Surgery ◽  
Training Model ◽  
Influential Factors ◽  
Case Volume ◽  
Surgical Trainee ◽  
Acceptable Error ◽  
Surgical Residents ◽  
Curve Model

AbstractA well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient.Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy.Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress.Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor’s ability, the trainee’s own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.

Comparative use of turkey and chicken wing brachial artery models for microvascular anastomosis training

2011 ◽  
Vol 115 (6) ◽  
pp. 1231-1235 ◽  
Author(s):  
Adib A. Abla ◽  
Timothy Uschold ◽  
Mark C. Preul ◽  
Joseph M. Zabramski
Keyword(s):  
Brachial Artery ◽  
Training Model ◽  
Vessel Diameter ◽  
Microvascular Anastomosis ◽  
Initial Model ◽  
Vessel Size ◽  
Training Models ◽  
Wing Model ◽  
Practice Models ◽  
Equidistant Points

Object The aim of this study was to describe a turkey wing model for microvascular anastomosis training and compare it to the previously outlined chicken wing model. Methods The authors compared diameter measurements in each of 5 turkey and 5 chicken brachial arteries at 3 equidistant points. Usable vessel length was measured (from joint to joint) in each of the specimens. A survey was created and distributed at a bypass training course to assess the attendees' impressions of various practice models used for bypass. Results The turkey wing brachial artery was consistently larger in diameter (p < 0.01) and longer (p < 0.01) than the chicken wing artery and showed less variability in the vessel diameter (1.47 ± 0.14 mm in the turkey vs 1.07 ± 0.25 mm in the chicken). In a survey of 15 bypass course participants, the live rat training model scored highest overall and was ranked as the best model for training; however, the turkey wing model was ranked second best and was consistently scored ahead of the chicken wing and silastic tube training models. Conclusions The authors' institutional preference has shifted to the use of a turkey wing artery as the initial model for microanastomosis training. Advantages in terms of vessel size and tissue durability favor this model over the chicken wing as part of a graduated instruction process.

Microvascular Anastomosis Training Model Based on a Turkey Neck with Perfused Arteries

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS407-ONS411 ◽  
Author(s):  
Mustafa E. Colpan ◽  
Konstantin V. Slavin ◽  
Sepideh Amin-Hanjani ◽  
Mateo Calderon-Arnuphi ◽  
Fady T. Charbel
Keyword(s):  
Carotid Arteries ◽  
Infusion Pump ◽  
Superficial Temporal Artery ◽  
Training Model ◽  
Maximum Pressure ◽  
Microvascular Anastomosis ◽  
Vascular Perfusion ◽  
Model Based ◽  
Circulation Circuit ◽  
Flow Through

Abstract Objective: The microvascular anastomosis (MA) technique remains an important aspect of modern neurosurgical practice. Specialized training is essential for mastering the anastomosis of small vessels. To minimize animal use and to create a simple but realistic training model, we developed a pulsatile perfused arteries model based on turkey carotid arteries for microvascular anastomosis training. Methods: Approximately 10-cm-long segments of turkey necks were used as a material to set up this model. The diameter of turkey carotid arteries at the neck level was found to be between 1 and 3 mm. Both carotid arteries on the neck segment were cannulated and incorporated into a closed circulation circuit consisting of silicone tubes and an infusion pump that provided continuous arterial-like flow and pulsation during the MA training. Tubing connection with both proximal and distal ends of the carotid arteries allowed circulatory patency during vessel clamping and anastomosis creation. Different fluids ranging from simple water to various colored solutions or even whole blood could be used for vascular perfusion in this experimental setup. Fluid output was maintained between 11 and 16 ml/min. Minimum pressure was set at 80 cm/H20, and maximum pressure was set at 160 cm/H20. Mean fluid flow through the arteries was 8 to 13 ml/min. End-to-end, end-to-side, and side-to-side MA may be performed on this model. Results: This training model provides several advantages: the materials are easily obtainable and inexpensive, pulsatile flow through the arteries is realistic, the model is easy to manage, and there is no need for special facilities for animal care or anesthesia that are required for live animals. The diameter and structure of turkey carotid arteries are essentially identical to the human cortical vessels and distal branches of the superficial temporal artery. Conclusion: The pulsatile perfused carotid arteries model presents a realistic MA training model. It provides an inexpensive and simple setup for educational purposes. This technique can minimize live animal and anesthesia needs for MA training. Wide use of this model may enhance and popularize MA training and education.

scholarly journals Validação de Modelo de Treinamento para Realização de Nós e Pontos Laparoscópicos em Ambiente de Simulação

2020 ◽  
Vol 44 (2) ◽  
Author(s):  
Grijalva Otávio Ferreira da Costa ◽  
Hermano Alexandre Lima Rocha ◽  
Cândida Mayara Rodrigues Carvalho ◽  
Luiz Gonzaga de Moura Junior ◽  
Francisco das Chagas Medeiros
Keyword(s):  
Learning Curve ◽  
Student Satisfaction ◽  
Linear Models ◽  
Statistical Significance ◽  
Abdominal Cavity ◽  
Total Duration ◽  
Training Model ◽  
Categorical Variables ◽  
Prospective Longitudinal

Abstract: Introduction: To evaluate the progression of competence, learning curve and degree of satisfaction with the training model of medical students undergoing training to perform laparoscopic knots in a simulator. Methods: This was a prospective, longitudinal, interventional study, carried out from April 2016 to July 2017, with the participation of 52 students from the Centro Universitário Christus, Fortaleza, Brazil, from the first to the third year of medical school, undergoing theoretical practical, systematic, and methodized training, with progression of skills to perform laparoscopic knots in a simulation environment in four stages, with a total duration of 16 hours. It was established the task of performing laparoscopic stitches, with five simple knots, in the beginning and in the end, in a suture mold, in an abdominal cavity simulator, in 18 minutes. The main outcomes were time and quality of performance. The students were evaluated before the first and after all stages of the training regarding the quantity and quality of the knots or the subject of the stage and satisfaction with the training model. ANOVA and Student’s t tests were performed for the independent samples and the chi-square test for the categorical variables. For variables with serial measurements, general linear models were used. Univariate binomial models were used in the evaluation variables of the training model. P values <0.05 were considered significant. Results: The values of the medians were analyzed between the first and last stages of the training; of the number of simple knots (0.0 and 15.0) and laparoscopic knots (0.0 and 3.0), the adequacy of the sizes of the suture tail ends (0.0 and 11.0), the number of adjusted initial simple knots ( 0.0 and 3.0) and adjusted sequential ones (0.0 and 24.0). There was statistical significance in all evaluated parameters (p< 0.001). The learning curve showed that 99.1% of the students attained competence. The degree of satisfactory evaluation of the training model was considered good or great in 97% or more, with statistical relevance in 8 of the 10 evaluated statements. Conclusions: The study demonstrated that the students showed competence progression and learning curve evolution. The degree of student satisfaction in relation to the training model stages was very significant.

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